• HCC Network - Practitioner Application

  • Hidden: Practitioner Status

  • The ​Practitioner Intake Form below is our opportunity to understand who you are, your work, and the scope of your offerings. 

    You can fill this form out at any time, and the HCC will review and respond to new applications in January & June each year.

    NOTE: There is no 'Save' option for this form. A PDF version is available for download to review all application questions and draft your responses over time. However, only applications submitted ONLINE are considered for the Network.

  • Are you ok with receiving texts or calls in the following situations?*
  • Please tell us how you would like to participate in the HCC Network? Please select ALL that apply.*
  • Hidden: Modality Categories
  • Are you currently practicing and or receiving new clients?*
  • Are you applying to the HCC Network in order to participate in this year's Fall Clinic?*

  • When submitting your application online, you will be asked to share your social media channels.

     

    We will also ask you to list the healing modalities you practice, as well as in which contexts you want to offer them as part of the HCC Network.

  • Getting to Know You

  • If you are new to the HCC, were you referred to be a practitioner by someone in the Network?*
  • Do you identify as... This question may be activating. We ask because we receive specific requests from our community for practitioners & for particular events geared towards members of our QTGNCI2S community.

  • Your Healing Work Background

  • Do you speak any languages other than English to the extent you are able to understand and communicate in a treatment session?*
  • In order to understand more precisely the range of people that can benefit from your services, please select ALL options that accurately reflect any areas of specialization you have:*

  • Information for HEALING CLINICS

  • Are you able to accommodate a 30-60 min session in a community healing clinic setting?*
  • Are you able bring your own supplies (tables, chairs, pillows, herbs, etc.)?*

  • Information for REFERRALS

  • Do you offer "house calls"? Or do you only see people at your office or treatment space?*
  • Do you offer the public a sliding scale? Would you be willing to see people who are referred to you through the HCC at a sliding scale?*
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  • When submitting your application online, you will also be asked to upload a photo file of your headshot for inclusion in our HCC Network Practitioner Directory and other listings.

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