Services Request Form

We'd love to work with you!

Habits for Hope is hard at work planning our roster of workshops and coaching programs.

Fill out the form below and be the first to know when services that match your needs and interests become available.

Looking to volunteer instead? Check out our Volunteer Application Form.

First Name*

Last Name*

Phone

Email*

City

State / Province

Which of our services are you interested in? Check all that apply.*Attending a Habits for Hope workshopSigning up for a Habits for Hope health coaching programPartnering with Habits for Hope to bring a workshop or program to your organization or groupOther (describe below)

For services mentioned above, would you prefer:*Virtual offerings only (e.g., Zoom video conferencing)On-location events only (as social distancing allows)No preference

Is there any additional information you’d like to provide to help us connect you with our resources?

Thank you!

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Please leave this field empty.

Reinforcing recovery, one habit at a time.