Reignwel Provider Application

At Reignwel Global, we are providing global access to mental health resources and alternative methods of support for creative people of color to reign well.  Please use this application to list your wellness services on our global platform.  

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Email *
Name *
First and last name
How did you hear about Reignwel? *
Do you have a website? (If not, please type "N/A") *
Current Social Media Handles: (Type "N/A" if not on Social Media) *
Are you open to providing pro-bono services for qualified persons in need? *
Do you work with adolescents? If so, at what age limit? *
 What wellness services do you offer? (Please check all that apply) *
Required
Are you limited to providing services to a specific area or region?  *
If  "YES", please list what state(s) and country you are limited to offering services in.
What languages do you offer sessions in?
How are your sessions conducted?
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Please list any additional mental health services or resources that you provide.
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