Become A Volunteer

If you are a psychiatrist and would like to volunteer your time to Physician Support Line, please fill out the form below. Note: You do not need any special malpractice insurance to be a volunteer.

Thank you for your patience! We are working as quickly as possible to get new volunteers’ information into our system. If you do not hear from us right away, do not worry! We have your info in a waiting list that we are tackling slowly but surely.

Legal Name

First Name

Last Name

Phone

(###)

###

####

State of Licensure

Select from the dropdown list below

Degree

Specialty

Residency Year / PGY (if applicable)

Additional information you'd like us to know:

How did you hear about us?