Intake Step 2

You are on the path to support. To link information across data submissions be sure to give the same email address on all forms.

To move your Application forward you must accomplish these steps:

1. Confirm that you RESIDE in California or STOP HERE

The care we provide is governed by legal boundaries and we may only serve California Residents. If you need support in other states please visit our RESOURCE page.

2. Watch these videos to make sure you are ready to try Somatic Therapy

Healing on Purpose - 5 minutes

Somatic Therapy is Different - 8 minutes

Clean Pain vs. Dirty Pain - 3 minutes

3. Fill out a Group Intake Survey - approximately 5 minutes

4. Fill out an Income Questionnaire - approximately 3 minutes

5. Confirm you understand Consent Forms - approximately 10 minutes

Once all tasks are accomplished, please complete the below items and SUBMIT... which will result in the 3rd and final step in this INTAKE process ~ an appointment to have a real conversation with a Healing Justice partner.

First Name

Last Name

What is your birthdate?

I accept that all participants in this program will attend Group Meetings and I have completed the Group Intake Survey Form

I accept that admission into this program requires me to invest in self-paced learning and practice and I am ready to try this somatic approach to mental fitness.

I accept that admission into this program is based on financial capacity and I have completed the Income Questionnaire

I affirm that the email address used on forms is listed above and that I will be on the lookout for INTAKE STEP 3 to arrive at that email address

INTAKE STEP 2 was submitted!

Click Here To Request An Appointment

INTAKE STEP 2

Clean Pain vs. Dirty Pain - 3 minutes

If you are in crisis or in need of immediate support, please call:

The National Suicide Prevention Lifeline 1-800-273-TALK (8255)