Be Well Service Resource Lists
Dear Provider,

Our mission is  is to empower and improve individual and community health by increasing equitable access to preventative wellness services for all and centered on groups that have been historically marginalized.

Thank you for adding your name to our resource list so that more of our community members can access your services. Your information will be shared via the lists outlined below on both our website as well as directly to local neighborhood centers and nonprofit organizations. For clarity regarding the types of services you offer, we created 3 separate resource lists: 

1. Weekly/Monthly Services (these will be services you offer on a consistent basis, whether that is weekly or monthly. This also includes limited series classes as well as Support Groups)

2. Workshops (these will be offered either 1 time or in a 2- 4 week series, 1-2 hours in length)

3. Special Events:  (includes things like being a guest speaker/panelist, participation at a neighborhood block party or all day event or other needs a community center may identify)

You will be listed on each separately according to how you want to engage. For example, if you offer a monthly class as well as a workshop you will be listed on both lists. 

Please allow a few weeks to review your form before we may update our list with your information. If you don't see your information on our lists by 3 weeks reach out to us at info@bewellcommunitycollective.com. Thank you!

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Email *
Your name *
Your title(s) *
Your license and/or credentials *
Your business name *
Your website (or, if not, your social media like FaceBook) *
Please share how you would like community centers to contact you (email and/or phone number) *
If your practice requires malpractice insurance, can you verify you have current coverage?  *

Do you feel you have appropriate knowledge to work with diverse populations with the understanding that your learning is never complete?


*
Do you feel you bring self-awareness, humility, curiosity, and compassion?
 *
If you offer an ongoing wellness service(s) please list the title and a brief description. Please add any age, participant, etc. requirements you may have.  

If you have more than one please list them in a way we can identify each of them separately. 
What is your fee for this service(s)? Us "Other" to indicate a specific amount. 
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If you offer a workshop(s) please list the title and a brief description. Please include the length of the workshop, any age, participant amount, etc. requirements you may have.  

If you have more than one please list them in a way we can identify each of them separately. 

*If you have already submitted a workshop you do not need to repeat information here. Just write "Already submitted." We will be updating your existing listing with your contact info and fee. If you wish to change or add another workshop pease complete as requested above. 
What is your fee for your workshop(s)? Use "Other" to indicate a specific amount. 
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If you are open to participating in a special community event please check all that apply. 
What is your fee for engaging in a special initiative? Use "Other" to indicate a specific amount.
Clear selection
Is there anything else you'd like us to know? 
Submit
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