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Healing Circle Invitation: An Act of Communal Mending

A Settling Note: Before you begin, take a single, deep breath. These circles are spaces for shared presence and witnessing. They are not intended as clinical therapy or crisis intervention. This form helps us ensure that the circle is the right refuge for your heart at this time.

First name

Last name

Preferred Pronouns:

Phone

Preferred Method of Contact

Which circle is your heart currently drawn to?

Grief

Climate Anxiety

Political Crisis

The "Space Between" (Self-Discernment) What threshold or transition are you currently standing on?

On a scale of 1–10, how much "space" do you feel you have in your nervous system right now to listen to the stories of others? [Scale 1–10] (1 = I am currently overwhelmed; 10 = I feel steady and ready to witness others.)

Is the loss or event you are navigating "active" (happened within the last few months) or is it a "long-tending" (historical) experience?

Safety & Resources: Are you currently working with a therapist, counselor, or medical professional?

If a topic in the circle becomes too heavy for your nervous system, what is your "anchor" or way of returning to yourself?

A Gentle Reminder: Our circles are peer-led and volunteer-supported. If you are currently in a state of acute crisis or active trauma, we may recommend one of our Loving Companion private sessions or outside clinical support before joining a communal circle. Is this something you are comfortable discussing during our Heart-to-Heart conversation?

Yes