USC Chan Lifestyle Redesign® Knowledge Mobilization Initiative

Lifestyle Redesign®
Certification

Practitioner Database Submission Form

You are eligible for inclusion on this practitioner database if you are Lifestyle Redesign Certified (LRC), or are a candidate for certification. Submit your information below as you would like it to be available in the searchable public database. Please make sure that you complete the required* fields.

Candidates will be indicated in search results by inclusion of '(Candidate)' in place of a certificate number.

We won’t share your contact details with anyone else and you can ask us to update/delete them at any time. (You can read our general Privacy Policy here.)

If you would like to remove yourself from this database or map, please email lifestyle.redesign@chan.usc.edu.

Thank you!

Your name and credentials

First / given name*
Last / family name*
Credentials (e.g., OTR/L)

Your location

Town / city*
State / territory*
Non-US state / province (write in full)
Zip / postal code
Country* (change if not USA)

Your contact details

Work phone number (if outside of the US, please include country code and area code)
Email address

Professional information

Employer

Certification information

Special Topics courses completed through the Foundations of Lifestyle Redesign Course Series*

(check all that apply)

	Chronic Pain
	Mental Health
	Multiple Sclerosis
	Sleep Disorders
	Weight Management

Lifestyle Redesign specialty area

Are you accepting new clients?*

	Yes
	No

Are you accepting new students (e.g., fieldwork or capstone) seeking mentorship in Lifestyle Redesign?*

	Yes
	No

About this submission

Please tell us a little more about this submission.

Is this a new, additional, or replacement record?*

	This is a new record (You don’t already have a record in the system.)
	This is an additional record (You already have a record in the system, and are adding an additional record. Both/all will be kept.)
	This is a replacement record (You already have a record in the system, and want to replace it. The previous record will be removed.)

Lifestyle Redesign®Certification