At Uzazi Village, we believe that healing and wellness are community rights. As part of our ongoing support for reproductive justice and whole-person care, we offer individual therapy and group healing services to eligible care participants and community members. These services are grounded in cultural humility, compassion, and a deep respect for your lived experiences.

This form helps us learn more about you so we can determine whether our therapy and healing services are the right fit for your current needs. It’s part of our process for making sure everyone receives care in a way that is safe, supportive, and aligned with their healing journey.

Please know that completing this form does not guarantee services, and it is not a crisis tool. A licensed or qualified mental health professional will review your responses to assess fit, safety, and capacity. We reserve the right to determine eligibility and may decline or defer services based on clinical judgment or program availability.

All information you share will be kept private and handled with care.

If you have questions, concerns, or need help filling out this form, we’re here for you. Thank you for trusting Uzazi Village to be part of your wellness path.