Provider Registration

Please read the following Terms and Conditions.
If you agree with the Terms and Conditions, please enter your name and select “I Agree” at the bottom of the page to continue with registration.

Upon joining the MilestonesNYC Provider Network, I understand, warrant, and agree to the following:

1. I agree to provide mental health, coaching, or other services in, and only in, the areas in which I am licensed, certified, or otherwise qualified to practice.

2. I agree to conduct my practice using the highest ethical standards and to respect and honor the dignity and individuality of those who seek my assistance.

3. To the extent that any malpractice claims have been filed against me, I enclose a separate sheet explaining the claims, including the details of the claims and the outcome of the claims.

4. I understand that MilestonesNYC will refer to me one or more individuals (Care Recipients). I agree to provide my services to Care Recipients on a volunteer basis. At no time will I charge Care Recipients for the services that I provide.

5. I will provide my services at my own office.

6. MilestonesNYC will provide my contact information to each Care Recipient who is referred to me. Each Care Recipient referred to me shall be asked to contact me directly to arrange a mutually convenient time for our first meeting. During and after my first meeting with each Care Recipient, I will schedule appointments with each Care Recipient at mutually convenient times.

7. MilestonesNYC specifically disclaims all warranties and liabilities regarding its Care Recipients. I am responsible for taking all precautions to ensure that each relationship that I have with a Care Recipient is a safe and successful one

8. MilestonesNYC does not provide therapy, coaching, or any other form of medical mental health. The referral of Care Recipients to Providers is not based on a thorough or complete medical or psychological evaluation of each Care Recipient

9. MilestonesNYC asks Care Recipients to confirm that the information that they provide is complete and accurate, but MilestonesNYC does not confirm the accuracy of such information. I understand that any information provided to me by MilestonesNYC concerning Care Recipients will not be verified by MilestonesNYC.

10. MilestonesNYC asks all Care Recipients to confirm that they have not had any recent thoughts of suicide, and are not seeking treatment for any chronic mental illness, alcohol or substance abuse. However, MilestonesNYC does not conduct a background check or other investigation of Care Recipients to verify such confirmation.

11. Neither my dealings with MilestonesNYC, my inclusion in the MilestonesNYC Provider Network, nor this Agreement shall create, or be deemed to create, a partnership, employment relationship or any other relationship between me and MilestonesNYC.

12. MilestonesNYC specifically disclaims all warranties and liabilities regarding Care Recipients and the referral process used by MilestonesNYC. MilestonesNYC does not guarantee that I will be satisfied with the referral process used by MilestonesNYC, or any other actions, processes, or services of MilestonesNYC.

13. I agree to indemnify and hold MilestonesNYC, its directors, officers, subsidiaries, affiliates, successors, assigns, agents, suppliers and employees, harmless from and against any and all claims, expenses or demands, including attorney fees and court costs, made by any Care Recipient or third party due to or arising out of the services I provide to Care Recipients.

14. I agree to release MilestonesNYC, its directors, officers, subsidiaries, affiliates, successors, assigns, agents, suppliers and employees, from any claim against me by a Care Recipient.

15. Any dispute relating in any way to my interaction with MilestonesNYC or to services provided by MilestonesNYC shall be adjudicated in any state or federal court in New York County, New York, and I consent to exclusive jurisdiction and venue in such courts.

16. The provisions of this Agreement are severable, and in the event that any provisions of this Agreement shall be determined to be invalid or unenforceable under any controlling body of law, such invalidity and unenforceability shall not in any way affect the validity or enforceability of the remaining provisions hereof.