1Basic information

Full name *Email *

2Location

Country *Province / Territory *City(optional)

3Professional verification

Regulation and professional titles vary by country and province/state. Please choose the closest option and use “Other” if needed.

Profession category *Registration / credential status *Regulatory body / professional association *License / registration / membership number *Professional profile or verification link

I do not have a public verification link.

4Practice details

Practice type *Plan you're interested in *

Anything else?(optional)

5Confirmation

I confirm that the information I provided is accurate and that I am requesting access as a mental-health professional or practice representative.

I agree that Ravanika may contact me by email about my access request.

I understand that Ravanika’s practice management tools are for use in the country my application is accepted for, and that I must not enter or store records for clients located outside it. See Scope of use in the Terms.

Optional: I would also like to receive occasional product updates and announcements from Ravanika Tech Inc. by email. You can unsubscribe at any time — every message includes an unsubscribe link.

By submitting, you agree to the Terms and acknowledge the Privacy Policy.

Submitting this form does not guarantee access. Ravanika may request additional information before approving an account.

Request access to Ravanika

You request access

We review and set up your account

You receive sign-in details

1Basic information

2Location

3Professional verification

4Practice details

5Confirmation