[{"id":"state_license_s_","type":"multiselect","question":"Please select the state(s) you are currently licensed in.","options":[{"value":"Alabama","label":"Alabama"},{"value":"Alaska","label":"Alaska"},{"value":"Arizona","label":"Arizona"},{"value":"Arkansas","label":"Arkansas"},{"value":"California","label":"California"},{"value":"Colorado","label":"Colorado"},{"value":"Connecticut","label":"Connecticut"},{"value":"Delaware","label":"Delaware"},{"value":"District of Columbia","label":"District of Columbia"},{"value":"Florida","label":"Florida"},{"value":"Georgia","label":"Georgia"},{"value":"Hawaii","label":"Hawaii"},{"value":"Idaho","label":"Idaho"},{"value":"Illinois","label":"Illinois"},{"value":"Indiana","label":"Indiana"},{"value":"Iowa","label":"Iowa"},{"value":"Kansas","label":"Kansas"},{"value":"Kentucky","label":"Kentucky"},{"value":"Louisiana","label":"Louisiana"},{"value":"Maine","label":"Maine"},{"value":"Maryland","label":"Maryland"},{"value":"Massachusetts","label":"Massachusetts"},{"value":"Michigan","label":"Michigan"},{"value":"Minnesota","label":"Minnesota"},{"value":"Mississippi","label":"Mississippi"},{"value":"Missouri","label":"Missouri"},{"value":"Montana","label":"Montana"},{"value":"Nebraska","label":"Nebraska"},{"value":"Nevada","label":"Nevada"},{"value":"New Hampshire","label":"New Hampshire"},{"value":"New Jersey","label":"New Jersey"},{"value":"New Mexico","label":"New Mexico"},{"value":"New York","label":"New York"},{"value":"North Carolina","label":"North Carolina"},{"value":"North Dakota","label":"North Dakota"},{"value":"Ohio","label":"Ohio"},{"value":"Oklahoma","label":"Oklahoma"},{"value":"Oregon","label":"Oregon"},{"value":"Pennsylvania","label":"Pennsylvania"},{"value":"Rhode Island","label":"Rhode Island"},{"value":"South Carolina","label":"South Carolina"},{"value":"South Dakota","label":"South Dakota"},{"value":"Tennessee","label":"Tennessee"},{"value":"Texas","label":"Texas"},{"value":"Utah","label":"Utah"},{"value":"Vermont","label":"Vermont"},{"value":"Virginia","label":"Virginia"},{"value":"Washington","label":"Washington"},{"value":"West Virginia","label":"West Virginia"},{"value":"Wisconsin","label":"Wisconsin"},{"value":"Wyoming","label":"Wyoming"}],"required":true},{"id":"10__license_type","type":"multiselect","question":"Please select your license type(s).","options":[{"value":"Clinical Social Worker (LCSW, LICSW, LISW, LICSW, etc.)","label":"Clinical Social Worker (LCSW, LICSW, LISW, LICSW, etc.)"},{"value":"Marriage and Family Therapist (LMFT, LCMFT, LIMFT, etc.)","label":"Marriage and Family Therapist (LMFT, LCMFT, LIMFT, etc.)"},{"value":"Mental Health Counselor (LMHC, LCMHC, LMHP, LPMHC, etc.)","label":"Mental Health Counselor (LMHC, LCMHC, LMHP, LPMHC, etc.)"},{"value":"Professional Counselor (LPC, LPCC, LCPC, etc.)","label":"Professional Counselor (LPC, LPCC, LCPC, etc.)"},{"value":"Psychologist","label":"Psychologist"}],"required":true},{"id":"how_did_you_hear_about_better_help_","type":"select","question":"How did you first hear about BetterHelp?","options":[{"value":"Internet Research","label":"Internet Research"},{"value":"Online advertisement","label":"Online advertisement"},{"value":"Friend or colleague","label":"Friend or colleague"},{"value":"Other","label":"Other"},{"value":"Podcast","label":"Podcast"},{"value":"Mail","label":"Mail"},{"value":"Email Outreach","label":"Email Outreach"}],"required":true},{"id":"complete_credentials","type":"text","question":"Please list your license number. For example, California LMFT 123456.","required":true},{"id":"agrees_to_be_an_independent_contractor","type":"select","question":"Do you understand that you will not be a BetterHelp employee, but an independent provider who provides services through the platform?","options":[{"value":1,"label":"Yes"},{"value":0,"label":"No"}],"required":true},{"id":"resides_full_time_in_the_us","type":"select","question":"Are you currently residing full time in the United States?","options":[{"value":1,"label":"Yes"},{"value":0,"label":"No"}],"required":true}]