HELP for Parents Network - Secure Client Area

Go as far as you can see and when you get there, you will see further!

Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Therapist

Client Information

Legal First Name / Middle Initial

Last Name

Preferred First Name ( optional )

Date of Birth
( MM-DD-YYYY )

Pronouns ( optional )

Gender Identity ( optional )

Street Address

Street Address 2

City

State

ZIP Code

How did you find us?
(optional) (required)

Cell Phone ( for Text Message Reminders )
Preferred Contact #

Home Phone
Preferred Contact #

Bill To Contact

Same as above Different

First Name or Organization Name / Middle Initial

Last Name

Street Address

Street Address 2

City

State

ZIP Code

Phone

Log in Details

( If client is a minor, the legal guardian must enter their email address below. )

Confirm Email

Username
Between 8 and 40 letters and numbers

Local Time / Timezone

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )

Question #1

Answer

Question #2

Answer

( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

HELP for Parents Network, Inc

All clients are required to sign the informed consent in order to participate in treatment. By checking this box indicates that I have read and I fully understand the terms & conditions of working with a therapist and/ or Life Coach at the HELP for Parents network. I am also agreeing that I have not been forced to choose the HELP for Parents Network, Inc and that it is my decision to work with this agency.

Electronic Signature of Client or Legal Guardian ( Type Full Name )
( Full Name )
I have read and I agree to the HELP for Parents Network, Inc