Register Account

Register for a New Account

Fill out the form below to create your account. All fields marked with an asterisk (*) are required. Once submitted, you’ll receive an email confirmation to complete your registration.

Welcome! Please complete the form below to get started. All fields marked with a red asterisk (*) are required.

First name

Last name

City/town

Country

Email address

Password

Your password must be at least 8 characters long and include a mix of uppercase letters, lowercase letters, numbers, and symbols.

What is your age?

What is your gender identity?

Which of the following best describes your race?

Which of the following best describes your ethnicity?

What is your highest degree earned?

If Other, please specify

Which of the following best describes your professional identity?

Other: please specify

Do you have a specialty or primary focus of practice/training?

Are you currently a student?

How many years have you been in your program?

How many years have you been working in your field?

Are you licensed and/or board-certified to practice independently?

Have you had prior experience or training in IBH settings?

Which of the following best describe your previous training or experiences with IBH?

Other: please describe

Security question

Required