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Get Started with The Healing Center

Get Started with The Healing Center

Seeking support takes courage and we're grateful you are reaching out to us.

Please fill out the form below to share more about yourself and the support you are seeking.

Due to a staffing shortage, our response time may be longer than 48 hours. We will respond to your request as soon as possible. Thank you for your patience.

    Personal Information

    Today's Date*
    Pronouns* She/HerHe/HimThey/ThemOther
    Your age* Teen (13-17)18-3031-6465 and overI'm not seeking services for myself.
    Are you seeking services for someone else?* YesNo
    Age of person seeking services* Child (4-12)Teen (13-17)18-3031-6465 and over
    Pronouns of person seeking services* She/HerHe/HimThey/ThemOther

    Contact Information

    Preferred Contact Method* PhoneEmailEither (no preference)

    Information on The Loss

    Person/People Loss*
    Manner of Loss*
    Time from Loss*

    Support Groups

    Which groups are you interested in?*

    More Information

    How did you hear about us?*
    Do you have any accessibility needs you'd like us to know about, including barriers to virtual participation?
    Is there anything else you’d like us to know?