Cultural Wellness Directory Registry

Name*

Name of organization or individual (if not an organization).

Address*

Phone*

General line where community residents can ask questions or make appointments.

Email*

Preferably an email that is checked regularly.

Credentials/Licenses*

Describe how the organization uses a trauma-informed lens in the practice?*

How would you describe your healing or therapeutic care practices?*

Please provide a description of the organization's specialties, including detailing the demographics of the communities your serve below.

Race/Ethnicity*

Select all that apply.

Select or enter value

Race/ethnicity not captured above

Population*

Select all that apply.

Select or enter value

Gender/Sexuality*

Select all that apply.

Select or enter value

Gender/sexuality not captured above

Services provided*

Select or enter value

Services not captured above

Do you currently have liability insurance?*

If you do not currently have liability insurance, it does NOT affect you becoming a Cultural Wellness Directory partner.

Select or enter value

Please upload your organization's logo & liability insurance.

By uploading this image, you are giving the Cultural Wellness Center permission to post this photo next to your provider profile.

Drag and drop files here or