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Haute Healing Oasis Practitioner Partnership and Event Hosting Intake Form

Welcome to the Haute Healing Oasis Practitioner Partnership and Event Hosting Intake Form. At Haute Healing Oasis, we are committed to fostering a holistic approach to wellness, covering all aspects of one’s being – from physical health to mental clarity and emotional well-being. Our aim is to create an innovative model for integrative wellness and community healing that combines traditional wisdom with contemporary practices to nurture body, mind, and spirit.

We invite healthcare providers and practitioners who share our vision to contribute their expertise and explore partnership opportunities for mutual growth and community enrichment. This form is designed to gather essential information about your practice, experience, and how we might collaborate to benefit the lives of those we serve.

Personal and Professional Information

Full Name: *

Professional Title:

Contact Number: *

Email Address: *

Website (if applicable):

Social Media Profiles (list all that apply):

Professional Background

Brief Biography: *

Qualifications and Certifications (include any relevant licenses):

Specializations: *

How long have you been in practice full-time?

Describe your approach to wellness and healing: *

References (Please provide contact information for at least two professional references): *

Partnership Proposal

Describe the nature of the partnership you envision with Haute Healing Oasis: *

What unique services or skills do you offer that align with the holistic and integrative wellness mission of Haute Healing Oasis? *

How do you believe your partnership with Haute Healing Oasis will benefit both parties? *

Have you previously partnered with other wellness centers or healthcare providers? *

If yes, please describe the nature of these partnerships and the outcomes:

Partnership and Community Engagement

As part of our collaborative journey, we invite our partner practitioners to join the Haute Healing Oasis community as members. This initiative aims to deepen your connection with our services and enhance the authenticity of your recommendations to clients.

Are you interested in becoming a member of Haute Healing Oasis? *

Which services at Haute Healing Oasis are you most interested in experiencing and potentially recommending to your clients?

Do you agree to authentically refer your clients to Haute Healing Oasis services that you believe will benefit their well-being? *

Are you interested in hosting an event, or would you like to become one of our preferred partners? *

Event Hosting Details (If applicable)

Proposed Event Title and Description:

Event Type

Workshop
Seminar
Retreat
Other

Target Audience:

Preferred Dates/Times, Duration, and Participant Number:

Room Setup and Equipment Needs:

Previous Event Hosting Experience:

Logistical Considerations

Are you seeking a physical space at Haute Healing Oasis for your services? *

Will you require support from Haute Healing Oasis staff? *

Vision and Goals

What are your short-term and long-term goals for this partnership? *

How does partnering with Haute Healing Oasis fit into your professional vision?

Additional Information

Other Relevant Information or Special Requests:

Agreement to Provide Insurance Documentation and Add Haute Healing Oasis to Policy *

Interest in Fee In-Kind Contributions (Optional):

Additional Comments

Terms for Using Haute Healing Oasis Facilities for Events/Workshops

• Revenue Split Agreement (60% Practitioner, 40% Haute Healing Oasis). • Marketing/Promotional Support Agreement. • Administrative Support for Event Coordination. By signing below, you confirm the accuracy of the provided information and agree to the terms outlined for partnership and event hosting at Haute Healing Oasis.

Signature (Type Name): *

Date: *

Address:
792 PACIFIC STREET
STAMFORD, CT, 06902

Phone: (203) 595-5304
Email: info@hautehealingoasis.com

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