Black Healers Directory Submission Form
Please fill out form below to be placed in our Black Healers directory. By completing this form, you consent to being reached out to with the contact information you provide via this form by members of our Black community to receive free services you are offering into our digital altar space. We also urge you to please apply directly for funding for The Black Healers Fund to compensate you for your services by submitting a funding request to nycpochealingcircle@gmail.com ; Subject line: Funding Request ; with a short statement of the services you are providing and funding needed. <3 With Heart, The NYC POC Healing Circle.
Sign in to Google to save your progress. Learn more
Email *
Email address *
Please confirm your email address to receive a receipt of your submission
Your Name & (Your Pronouns) *
Phone Number
Social Media
Please share which platforms you are open for your clients to learn more about you and your offerings. Please write next to it which platform it is ( i.e. IG (instagram); TW (twitter); FB (facebook) etc.)
Offerings *
Please write below an ITEMIZED list of your clients as clients with use the CTRL/COMMAND + Find option to search terms for services in the directory. Please be as SPECIFIC, CLEAR and CONCISE as possible. ( i.e. reiki, tarot readings, aura clearing, mental health support, therapy, peer emotional support, doula care, grief/bereavement support, etc.)
Identities *
Please list your identities below (ethnicity, race, age, sexual orientation, gender identity, expression, etc) that you would find helpful for your clients in choosing your services.
Languages Spoken / Available *
Please share language accessibility options for clients that you may be able to provide for clients (i.e. English, Spanish, ASL (in language), etc.)
Offering Format *
Please LIST the platforms and formats you are comfortable providing your offerings over. i.e. Zoom, Skype, Google Video, Phone, Skype, Whatsapp Video/Phone, Signal Video/Phone, Google Voice, In-person, specific location, venue, etc, etc.
Anything additional you would like clients to know?
Please read the following: The NYC POC Healing Circle Honor Code and Healers Oath

The NYC POC Healing Circle Honor Code & Healers Oath

I solemnly pledge and honor to provide my care, services, and offerings to my community in the service of Black Liberation, abolition, and the entrusting of collectivist community care practices.

I will practice responsibly with self-awareness, integrity, dignity, and humility which are consistent with the values, ethics, and practices that are mindful of trauma-informed care [1], harm-reduction approaches [2], and reparations frameworks [3], that acknowledge the longstanding histories of anti-blackness, white supremacy, and universal oppression and suffering that exists in society and on this earth.

I will prioritize the peace, happiness, safety, health, and well-being of my client as I respect their truths that may be confided in me, even after my offerings are provided.

I will remain accountable to and honor the Black, Indigenous, and/or People of Color traditions of healing practices in our shared and different cultural lineages, heritages, and histories. I will practice and serve with my client’s best interests, needs, and wants prioritized and centered during our session time. To this aim, I will be aware of oppression, universal injustices, and most explicitly anti-blackness in my healing practices where I will be aware of and tend to the considerations of gender, age, religion, race, ethnicity, sexual orientation, ability, political philosophy/ideology, and/or socio-economic standing and other power, oppression, and/or privilege dynamics that may be present between me and my client and thus provide my offerings with the utmost care through an anti-oppressive lens.

If I feel that I cannot provide or follow through on my offerings for any reason at any time, or if I feel I have caused any misstep or harm in my practices I will notify the nycpochealingcircle@gmail.com to be held accountable to my commitments and contributions to the collective, our community, and this Honor Code & Healers Oath.

In my practices and offerings I will honor, respect, and be compassionate towards every human being.

I take this oath solemnly, freely and upon my honor.

This oath is an affirmation of why we choose to become healing practitioners to serve our communities and greater humanity in our shared goal towards Black Liberation.


--------------------------------------------
[1] Trauma-informed care is the recognition of how common trauma is, and understands that every client and/or person we interact with may have experienced serious trauma in their lifetime. Trauma-informed care does not question people about their experiences or ask them to qualify/quantify them, but rather, that we assume that they have had this history and thus provide care that is sensitive, caring, and always prefaces care delivery with consent and transparent communication (checking-in physically/emotionally/mentally and  asking for permission), as well as and prioritizes the consent of the client.

[2] Harm-reduction approaches center the priorities and immediate needs of the client, while trying to cause and/or create the LEAST harm possible in the process. An common example of harm-reduction approaches is clean-needle exchange, where, although clean-needle exchange programs do not promote the use of intravenous drug-use, such programs prioritize the safety of clients to use clean needles in safe places to inject drugs to reduce harm of chance of  with non-judgement and unconditional support of the client’s needs. Harm reduction prioritizes the safety of clients through non-judgmental and  non-coercive support which are intended to lessen the potential negative social and/or physical consequences associated with various human behaviors that may be perceived to be both legal and/or illegal.

[3] Reparations frameworks acknowledges that those who have been subject to historic human rights violations, mass genocide, war crimes, violence, +++,  especially the Black community globally, has the universal human “right to reparations” (Universal Declaration to Human Rights, Art. 8) to publicly address and recognize the harms caused, suffered, and endured. The parameters of the reparations must be delineated by those who were subject to such violations and can only be deemed satisfactory by them. Reparations can take the form of making verbal or textual amends to the wrong that was done; monetary amends, retributions, or physical restitutions to what was lost; etc. Reparations frameworks are ongoing as violations of oppression are also ongoing, pervasive, and perpetuated by universal white supremacy and the cis heteropatriarchy.  
Do you agree to and have read our Community Practitioner Honor Code & Healers Oath above? ( A digital copy of the Healers Honor Code and Oath is also is available here for your reference: https://docs.google.com/document/d/18Ho1486FE_n50FEp8ffArtTNqtC3Enw0CbOkF7kSRr4/edit?usp=sharing ) *
Please digitally sign your full name below in acknowledgement of reading and agreeing to The NYC POC Healing Circle Honor Code and Healers Oath as well as consenting to be contacted freely by community for your services through the NYC POC Healing Circle's Black Healers Fund.
Signature *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy