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YHM Referral Form

Thank you for helping us connect with those who need healing support. Please complete this referral form so we can follow up with care and intention.

Your Relationship to the Person You’re Referring:

Person Being Referred

Best Way To Reach Them
Phone
Email
Text

Reason for Referral

Please select any that apply to you:
Has the person being referred agreed to be contacted by Your Healing Matters?
Yes
Not yet — please reach out through me
No — just exploring options

We honor the privacy and dignity of every person referred to us. Thank you for helping us extend healing with intention and care.

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