Let’s Wellness in 2025!Let’s build a Filipina/x/o Wellness Movement TOGETHER Name * First Name Last Name Email * Address Address will be kept confidential. Please provide address to receive free gifts, and be connected to regional Therapin*y network chapters Address 1 Address 2 City State/Province Zip/Postal Code Country Location/Region Where do you reside, and/or licensed for service within? This will allow us to connect you to others in your regional network Would you like to be added to our regional chapter listserv? * Currently, we have Therapin*y chapters in Chicago-Midwest, Greater Los Angeles, San Diego, & San Francisco Bay Area. Benefits of joining a chapter: - Professional development opportunities - Networking - Clinical consultation & support - Decision-making power in Therapin*y - Community events - Newsletter highlights - and more... Yes No I'd like to open a chapter for my region! Please contact me! Let's wellness together! Which Wellness-Together offering are you interested in? * Monthly Therapin*y Provider meet-ups (virtual and/or in-person) Social time - give me that happy hour, that dancing sayaw, that karaoke time Lead a wellness activation or workshop at an upcoming event! Sign me up for mutual aide & scholarship opportunities for my clients! Other... If "other" please specify below: I am able to help Therapin*y grow by: choose one or more actions that you are able to do in order to help advance Therapin*y's wellness movement Join or start a regional chapter within the Therapin*y Kapwa Network Join a committee (e.g., events, education, fundraising, marketing) Guest author for blog/social media Donate, Sponsor, or Invest in Therapin*y Other... If "other" please specify below: ALSO.....CAN WE BRAG ABOUT YOU?? If you didn't know yet.... We LOVE to brag about our amazing Therapin*y Providers! Let us know more about your specialties, the community you serve, and how we can highlight YOU! Do you identify and serve a particular community? Please indicate which community you'd like us to include you in when sending our community newsletters, provider highlights, and/or social media content LGBTQIA+ Psychedelic Integration Therapy Parenting/Motherhood/Fatherhood Military, Veterans Religion-focused, spirituality, and/or faith-based Open-relationship, non-monogamy Adoption, Fostering, Surrogacy Aging & Elder community Psychosis & Schizophrenia Eating Disorders/ Disordered Eating Social Justice & Activism Teens & Adolescents Toddlers, Children, Kids Offers FREE/LOW-COST Sessions Biracial, Multi-racial/ethnic Addiction, Substance Immigration Do you identify and serve the LGBTQIA+ community? Please indicate which specific LGBTQIA+ community you'd like us to include you in when sending our community newsletters, provider highlights, and/or social media content LGBTQIA+ Queer Lesbian Bisexual Transgender Queer-competent Asexual or agender Two Spirit Intersex Do you identify and serve the neurodiverse community? Please indicate which specific neurodivergent group you'd like us to include you in when sending our community newsletters, provider highlights, and/or social media content General neurodivergence Autism spectrum ADD/ADHD OCD Tourettes Learning disability Other Do you identify and serve as a sex therapist, and or AASECT Certified? Please indicate which specific qualifications or specialties would you'd like us to include you in when sending our community newsletters, provider highlights, and/or social media content AASECT certified Sexual abuse, sexual trauma Low/Discrepant Desire Kinks/Fetishes Sex Addiction Sexual Pain, or Difficulties Achieving Orgasm Erectile Difficulties, Premature Ejaculation & Delayed Ejaculation Sexual Infidelity THANK YOU for being part of our Therapin*y community! Any questions or kapwa love you'd like to share: Thank you! We are committed to uplifting our Therapin*y providers to build a movement for Filipino/a/x wellness & healing! Please tell us more about yourself and how you’d like to collaborate with us
