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Collaboration Form
Greetings!
Thank you for showing interest in collaborating with TherapHeal. Please fill this form so we can understand you and the your requirements well.
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* Indicates required question
Email
*
Your email
Name of your Organization
*
Your answer
Organization's address/location
*
Your answer
Name of the point of contact
*
Please name the person we can reach out to, for any further discussion/queries/proposal etc.
Your answer
Designation of the point of contact
*
Your answer
Email address of point of contact
*
Your answer
Phone number
*
Your answer
To which sector does your organization belong?
*
Healthcare (Hospital/Clinic)
Educational (Schools/Colleges)
NGO/Social Work
Corporate
Mental Health Care
Other:
Required
Please provide us a brief of the kind of work your organization is involved in
*
You could also provide us a link to your website/social media pages
Your answer
Please tell us about the nature of proposed collaboration
*
Mention the expected deliverables at both ends (from your organization and from TherapHeal)
Your answer
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