Practitioner Application

Equal Access to Health Alternatives

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Name*

Email Address*

Modality/Type of Service Provided*

MassageEnergy Healing/ReikiAcupunctureCoachingSound HealingAromatherapyAyurvedic medicineNaturopathyReflexologyOther

Phone*

Mailing Address

How did you hear about OHF?

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Type of Membership

Solo Practitioner $75Wellness Center/Business $150

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This fee is non-refundable and used to support OHF programs/services. If you have questions, call (860) 861-9038

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