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Are you interested in receiving services at Sana Healing Collective?
Please complete this inquiry form, and a member of our team will follow up with you soon.
Contact Information
Name
*
First Name
Last Name
Date of Birth
*
(mm/dd/yyyy)
Email
*
Verify Email
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Phone
*
Which SHC services are you interested in receiving? (check all that apply)
*
Group
Individual
Ketamine-assisted therapy
Psychedelic Integration
Art Therapy
Somatic Therapy
Meditation-based Therapy
Spirit Lab
How did you hear about us?
*
Please let us know how you found out about Sana. If you were referred by a therapist or other provider, please note their name.
OPTIONAL: Please briefly explain why you are seeking services from Sana Healing Collective at this time.
Do you currently have a primary therapist?
*
Do you wish to use your health insurance to pay for services? If so, who is your provider (specify HMO or PPO)?
*
Do you have a preference with which provider you will work?
If you have a preference for a therapist please let us know. While we will do our best to ensure you get paired with your preferred therapist, availability and other factors may impact which therapist(s) are available to work with you.
select one
Geoff Bathje
Vilmarie Fraguada Narloch
Valery Shuman
Eric Majeski
Avery Ravitz
Jean Edrada (for Spirit Lab only)
No Preference
