MyDuiGuy.com Associate Counselor Program

"The time is here for addiction counselors to join cyberspace."

MyDuiGuy.com Associate Counselors receive alcohol/drug evaluation referrals direct from our international evaluation services center. It is a very attractive way to earn extra money from your home or office, leaving all the marketing and fee collection to us.

To qualify for an interview you must be licensed, certified, or otherwise qualified (physician, licensed psychologist, etc.) to evaluate and diagnose alcohol/drug addiction in your state or country. Interns and candidates for licensing cannot be accepted because we do not provide clinical supervision or clinical training.

If you are interested in more information about our Associate Counselor Program, please fill out and submit the Interview Request form below.

I sincerely hope you will join our association of addiction counselors.

Larry H. Turner, NCAC II, CADAC II, LAC
Licensed Addiction Counselor in North Dakota and Minnesota
Springtime Counseling/MyDuiGuy.com

* = required fields

PERSONAL INFORMATION

* Name

* Address

* City

* State

* Country

* Zip

* Phone number where we may contact you.

Fax

* E-mail address where we may contact you.

Alcohol/Drug Counseling Experience

Are you Licensed as an addiction counselor?

	Yes
	No

State

Country

Are you Certified as an addiction counselor?

	Yes
	No

	IC & RC Certification
	NAADAC Certification
	Other Certification

State

Country

If you are not a Licensed or Certified addiction counselor, what are your qualifications to diagnose Substance Use Disorders?

	Physician
	Psychiatric RN
	Licensed Psychologist
	Other

Are you qualified to receive third party reimbursement in your state?

	Yes
	No

How long have you been practicing in the alcohol/drug addiction field?

	Years
	Months

Do you have supervisory experience?
(not a qualifying demographic)

	Yes
	No

Education Level

Less than 4 year degree:

A four year degree:

Masters degree:

Doctorate:

Code of Ethical Conduct

Have you ever had your license, certification, or other authority to practice addiction counseling, medicine, or psychological counseling suspended or revoked?
(If you answer yes, we will discuss privately.)

	Yes
	No

Your Present Computer Equipment

Computer

	Mhz
	Pentium
	Other

Modem Speed

	Kbps
	ISDN/Wireless
	Other

Type of internet access you have, i.e.
Dial-up, Cable, DSL, T1, etc.
(All Associate Counselors must provide their own access to the internet. We do not pay your monthly access fees.)

Do you currently own a webcam?
(All Associate Counselors provide their own PC camera. )

	Yes
	No

Professional Liability Insurance

All Associate Counselors must provide personal professional liability insurance coverage. MyDuiGuy.com does not provide an umbrella liability policy as Associate Counselors are independent contractors and are in no way employees, partners, agents, sales reps, franchisees, or joint venturers of or with Springtime Counseling Center/MyDuiGuy.com

Larry Turner will contact you by phone or e-mail regarding your Interview Request. At that time the complete Associate Counselor Agreement will be e-mailed to you in PDF format. You will need Adobe® Acrobat Reader to view and print this Agreement.