WeGiveBack Massage Application

Before applying please take a minute to read the following information:

Ohana Therapeutic Massage provide free massage as part of our WeGiveBack program quarterly. Each quarter one person will receive four sessions free of charge.

This application period runs from October 1, 2019 to October 15, 2019. A recipient will be chosen and notified by October 22, 2019.
This is a scholarship of need. Please only apply if massage sessions would constitute a financial burden without assistance.
Sessions must be redeemed within the chosen month of the WeGiveBack Program. Sessions cannot be redeemed for any cash value, gift certificates or product purchases. WeGiveBack sessions cannot be gifted or transferred.
The person hoping to receive the sessions must be the one to complete the application. If they are unable to do so, they can do so with the help of a care provider or a loved one but must have a part in the process.
Recipient must respond within 5 business days of being contacted in order to receive the scholarship. If there is no response after 5 business days, a new recipient will be chosen.

For complete details, see our WeGiveBack Massage Information on our website: www.ohanatherapeutic.com/wegiveback

Please fill out and submit the form below. Questions with asterisks (*) are required.

Question Title

* 1. Please enter your contact information

Name *

City/Town

State/Province

Email Address *

Phone Number *

Question Title

* 2. Where did you hear about the scholarship from?

Question Title

WeGiveBack Massage Application

Before applying please take a minute to read the following information:

Question Title

* 1. Please enter your contact information

Question Title

* 2. Where did you hear about the scholarship from?

Question Title

* 3. Household income level

Question Title

* 4. Household size

Question Title

* 5. Would you be able to afford massage without assistance?

Question Title

* 6. What is the primary condition you are hoping to address with massage?

Question Title

* 7. How long has this bothered you?

Question Title

* 8. Have you previously seen health care providers for this concern? If there has been a diagnosis or diagnoses please include that information.

Question Title

* 9. Are you willing/able to do recommended self care at home?

Question Title

* 10. Are there any other considerations you'd like taken into account?