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.
Race/ethnicity not captured above
Population
*
Select all that apply.
Gender/Sexuality
*
Select all that apply.
Gender/sexuality not captured above
Services provided
*
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.
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.
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