Healing Through Connection Program - Interest Form

Thank you for your interest in the Healing Through Connection Program at Indraloka. We are excited to partner with you and your patients for a transformative experience. Please fill out the form below, and one of our team members will be in touch soon to get you on the schedule!

Program Details:

* 2-4-hour session with inspiring stories, hands-on volunteering, and group reflections.

* $35 per participant, per visit, for a 12-month commitment or $50 per participant for a one-time visit.

Interest Form

Facility Name

Contact Person First Name

Contact Person Last Name

Phone Number

Email Address

Number of participants per visit

Preferred Visit Frequency

Monthly
One-time visit

If you selected "One-time visit," then please provide any additional information or requests:

Timeout Warning

Healing Through Connection Program - Interest Form

Program Details:

Interest Form