Service Interest Form

Thank you for your interest in working with us to assist your agency or system in implementing, growing, and sustaining your DBT program. We would be happy to talk to you directly about a specific training plan that meets the needs of your agency. Fill out the form below to reach one of our team members so we can customize a plan for you!

Agency Name(Required)

Agency Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Contact Regarding Training(Required)

First Last

Primary Contact's Agency Affiliation and/or Title(Required)

Email(Required)

Office Phone(Required)

Extension (where applicable)

Mobile Phone

Please tell us more about your training request so we can connect you with the appropriate resources here at Behavioral Tech Institute.

• What is the reason for your request/what prompted you to contact Behavioral Tech Institute?(Required)

• What are your training goals?(Required)

• Describe any previous DBT experience or training.

• What aspects of DBT are currently offered at your program or throughout your organization?(Required)

• What populations do you serve/who are your clients? And in what settings?(Required)

• What is the anticipated number of attendees you plan on participating in the training?(Required)

• What would be the make-up of the audience for the training? (Clinicians? Social workers? Front line staff?)(Required)

• What is your timetable?(e.g., proposed timeline for deliverables, fiscal deadlines, grant deadlines, etc.)(Required)

Click submit below to enter your responses.

Phone

This field is for validation purposes and should be left unchanged.