Covid Circles of Healing Survey
This survey is meant for Native American, Indigenous, or Alaska Native members in the Denver Metro area that have been impacted by a loss due to Covid-19.  Loss could be housing, employment, a family member, community, educational growth, or stability.
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Are you a Native American, Indigenous, or Alaska Native Colorado resident who lives in the Denver Metro area?

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What is your age?
 *

Which of the following BEST captures your gender identification?


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Select the option that BEST describes your health insurance coverage.


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THE FOLLOWING THREE QUESTIONS ARE RELATED TO THE COVID-19 PANDEMIC AND WILL BE USED TO UNDERSTAND THE NATURE OF HOW COVID-19 HAS IMPACTED YOU. PLEASE FLIP TO COMPLETE PAGE 2.
1. Since March 2020, have you experienced any of the following as a result of Covid-19? (select all that apply)
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Required
2. Since March of 2020, have you experienced any of the following symptoms related to loss during Covid-19? (select all that apply)
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Required
3. Are you interested in joining a Circle of Healing group focused around Covid-19 loss and healing with community members in a safe and confidential space at no cost? Food and drinks will be provided.
*
Are you interested in individual therapy related to Covid loss? *
Please SUBMIT this form and also click on link below to complete the interest form to attend a covid healing group.
Link to Covid Circle of Healing Interest Form
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