Healing Forces Foundation Eligibility

At the heart of the Healing Forces Foundation's mission is the belief that health is a fundamental human right. The organization is committed to extending a helping hand to those who may otherwise be unable to access crucial healing services. Its primary aim is to alleviate suffering, restore health, and enhance the quality of life for its beneficiaries, regardless of their background, financial situation, or social status.

Please take a few moments to complete this short form to see if you are eligible for our program and request services.

~Healing Forces Foundation is a 501(c)(3) charitable organization~

Name*

First NameLast Name

Address (Where service will take place)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Requested appointment date and time:*

Healing Services (Please only choose ONE)*

60min Mobile Massage$ Free

Let our incredibly talented and licensed massage therapists come to your home and provide a personalized bodywork session that is 100% tailored to your wants and needs.

60min Mobile Reiki session$ Free

This Reiki energy work offers a transformative healing experience delivered directly to your location of choice. A certified Reiki practitioner will come to you, creating a serene and comfortable environment for your session. During the session, you can expect to relax fully clothed as the practitioner uses light touch or hands hovering above your body to channel healing energy.

60min Couples Mobile Reiki and Massage Experience$ Free

((BOTH partners must fill out an eligibility form for this service)) Embark on a unique journey with a partner or friend, seamlessly blending massage and reiki for a profound experience. In the first phase, enjoy the soothing touch of either reiki or massage by our skilled practitioners, guiding you both into deep relaxation. Then, in a harmonious transition, practitioners swap roles, creating a fusion of energies that soothe the body and nurture the soul—an unparalleled experience in rejuvenation and connection.

Name of couples experience partner

(both of you are required to fill out an eligibility form)

Please choose one of the following reasons why you are seeking free services with Healing Forces:*

Severe Medical HardshipSevere Emotional HardshipSevere Circumstantial HardshipOther

Please explain*

In order to receive free services through Healing Forces, financial hardship may need to be present. Please select the reason for your current financial hardship:*

DisabledFixed IncomeCircumstantial Financial hardship

Please explain*

Please state your annual household income*.*

*Annual Household Income is the combined earnings for one year of all adults sharing a residence.

How many people are in your household?*

I hereby affirm the veracity and accuracy of the above responses to the best of my knowledge. I acknowledge the gravity of providing truthful information and am cognizant that any deviation from this commitment may result in legal repercussions aimed at securing equitable compensation for any unwarranted services rendered.*

I affirm and acknowledge

You agree that all your answers are true to the best of your knowledge.*