Copy of Healing Connections Question Title * 1. Contact Information Name Address Address 2 City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. Are you and Ohio State University Student? Yes No Question Title * 3. List 3 times you are available for a phone call, which you will receive from 614-395-1395. Question Title * 4. Are you vaccinated against covid-19? Yes No Done