Practitioner Portal

The Information Spot

Lease and Hourly Rental Payments

Core

Adjunct/Visiting

Core Hourly Rental

$20 / Hour

Pay Now

Core Lease Payment

See Lease

Pay Now

Adjunct/Visiting Hourly Rental

$25 / Hour

Pay Now

Lease Payment

See Lease

Pay Now

Practitioner Participation Program Payments

Core Practitioner

Annual Fee

$425 /Year

Pay Now

Adjunct Practitioner

Annual Fee

$200 /Year

Pay Now

Visiting Practitioner

Annual Fee

$100 /Year

Pay Now

Practitioner Forms

Practitioner Application

Practitioner Room Space Application

Email *

Name *

Name

First

Last

Business email address *

Phone *

Please indicate if we can give your phone number to potential clients

Yes

Address *

Address

City

State/Province

Zip/Postal

Country

Business name

Business website

Credentials

Types of services you offer

Are you applying to

Provide individual counseling and/or facilitate group,

Facilitate classes /workshops: fee-based or free Heart of Service

Please give a brief description of the modalities/techniques or that you use during your work with clients or teaching in classes

Please list experience doing this work previously

Is your profession required you to registered with DORA in Colorado

Yes

Is professional liability insurance available for your profession

Yes

Please upload current professional resume

Maximum file size: 104.86MB

Please upload a copy of your DORA registration

Maximum file size: 104.86MB

Please upload a copy of your professional liability insurance

Maximum file size: 104.86MB

Give 2 Professional references

I have thoroughly read and understand the People House Professional Participation Levels & I wish to become...

Core Practitioner - $425/Annually

Adjunct Practitioner - $200/Annually

Visiting Practitioner - $100/Annually

HoS facilitator - no charge

Have you used space at People House in the past?

Yes

If yes, when?

If no, how did you hear about People House?

Have you ever been convicted of a felony?

Yes

If yes, please explain

If you are human, leave this field blank.

Practitioner Referral Form

Name *

Name

First

Last

Pronouns

Credentials *

Business name

Business contact information

Phone *

Email *

Website

Where is your in-person office? *

Denver

Aurora

North Denver Metro

Virtual only

OtherOther

Address of your in-person office (will be visible to potential clients)

City

State/Province

Zip/Postal

Country

Do you offer telehealth sessions? *

Yes

Who do you work with? (Check all that apply) *

Individuals

Couples

Families

Children

Do you offer sliding scale? *

Yes

If yes, what are your sliding scale rates?

What are your general rates? *

Do you accept insurance? *

Yes

If so, what kind?

Additional comments

What modalities do you practice? (Check all that apply) *

Acceptance & Commitment Therapy (ACT)

Attachment Based Behavioral Therapy (BT)

Client/Person-Centered Therapy

Internal Family Systems (IFS)

EMDR/Eye Movement

Narrative

Cognitive Behavioral Therapy (CBT)

Dialectical Behavioral Therapy (DBT)

Emotionally Focused Therapy (EFT) for Couples

Family Systems Therapy

Integrative

Jungian Psychotherapy

Motivational Interviewing Therapy

Neurofeedback

Narrative Therapy

PACT

Play Therapy

Solution-Focused Brief Therapy (SFBT)

Somatic

Strength-based Therapy

Trauma Focused Therapy

OtherOther

What are your specialties? (Check all that apply) *

Addiction

Aging

Anger Work

Anxiety

Boundaries

Career

Co-parenting

Communication

Conflict

Cross-cultural conflict

Depression

Disordered Eating

Enneagram

Family of origin issues

Finding purpose and meaning

Grief/Loss

Individuation

LGBTQIA+

Men's issues

Mindfulness

OCD

Parenting

Polyamorous & Non-traditional relationships

Relationship issues

Self harm

Sexual abuse/assault

Sexuality

Somatic

Spiritual growth

Stress

Substance use

Transitions/Life change

Trauma

Veterans

Women's issues

OtherOther

Please list any other languages besides English that you are comfortable conducting sessions in, if applicable

If you are applying to become a Core Practitioner, please write in your bio here

What else would you like clients to know when referring?

If you are human, leave this field blank.

Ethical Guidelines

Ethical Guidelines for People House Facilitators & Group Leaders

These guidelines have been delineated in order to create safety for participants in PH "Heart of Service" programs as well as for clients of professional practitioners using PH space for groups.

1. Explain, discuss and require confidentiality in group.
2. Be as present as possible with everyone in the group.
3. Honor people's process even if you disagree with it. Be respectful, have 100% positive regard and empathy as
you honestly and congruently express yourself.
4. If it is your own group, it is certainly good to state your preferences and rules for participation as long as they
do not conflict with P. H. guidelines, but be flexible in enforcing them. Participants do not have to live up to your
or our expectations of group participation.
5. Refrain from all conduct that could be interpreted as invasive, threatening or sexual. Ask for permission from
participants to do confrontation or for physical contact such as hugs. Remember that some people are more sensitive to this than other people are. Sexual relationships with group members are never appropriate and are prohibited.
6. When you are a group leader or facilitator, be aware of and sensitive about the power differential between you as group leader and others as group members.
7. Be willing to accept feedback from group members without becoming defensive. Realize that facilitators and leaders are in their own process also and can learn from the group.
8. Have your own peer or supervision group in which you are a participant and in which you can discuss your problems and speak your truth. Bring problems that arise as a facilitator to a predetermined support group, mentor or
supervisor.
9. If you are not a qualified professional, do not attempt to diagnose or treat any group participant.
10. If you suspect a group participant is in danger of harming him/herself or another, consult with your mentor, supervisor or a qualified professional to determine the appropriate intervention.

Name *

Name

First

Last

Email *

Signature *

Clear

Date *

If you are human, leave this field blank.

Memorandum of Understanding

Letter of Understanding

As a visitor/tenet to People House and in using room space here:

You agree to hold harmless People House from any and all liability, civil or private legal action as a result of your activities or those of your clients/associated while at or as a result from your activities at People House.

You agree that you hold the credentials as stated in your application and resume, and have current applicable license(s) as required by the State of Colorado and the City of Denver to conduct your business.

You agree that you are a private participant and are not legally affiliated with nor an employee of People House, the Board of Directors, or the Ministers of People House.

You agree that if you are the last person out of the building of People House, it is your responsibility to turn off all lights and lock that front and back doors.

You agree that, in return for access and usage of our tables, chairs, coffee pots, mugs, dinner ware, etc., that you return all items to appropriate storage areas and placed all used dishes in the dishwasher. You also agree to close windows upon departure from your rented space and that the electronic appliances in the kitchen are turned off before you leave.

You agree to all the terms and conditions as stated in the Policies and Guidelines for Room Use at People House.

Participation Agreement:

Name *

Name

First

Last

Signature *

Clear

Date *

Mailing Address: *

Mailing Address:

City

State/Province

Zip/Postal

Country

Email *

Phone 1 *

Phone 1:

Cell

Home

Office

Phone 2

Phone 2:

Cell

Home

Office

Staff Contact Information

Veronica Dieda: Executive Director
303-480-5130; veronicadieda@peoplehouse.org

Samantha Oberhausen: Office Administrator
303-480-5130; samanthaoberhausen@peoplehouse.org

Mackenzie Martin: Administrative Assistant
303-480-5130; mackenziemartin@peoplehouse.org

If you are human, leave this field blank.

DORA Registration (UPLOAD)

DORA Registration Upload

Please upload your DORA Registration

Name *

File Upload

Maximum file size: 104.86MB

If you are human, leave this field blank.

Professional Liability Insurance (UPLOAD)

Professional Liability Insurance Upload

Please upload your Professional Liability Insurance

Name *

File Upload

Maximum file size: 104.86MB

If you are human, leave this field blank.

Disclosure Statement (UPLOAD)

Practitioner Disclosure Upload

Please upload your Disclosure Statement

Name *

In addition to the Mandatory disclosure of information to clients required by Dora, People House requests that you also add the following language to your disclosure form:

I rent office and/or workshop space at People House, which is neither my employer or agent. Neither People House Board Members, staff, nor any other practitioner, is in any way responsible for my services or activities.

File Upload

Maximum file size: 104.86MB

If you are human, leave this field blank.