Your Information *

First Name

Last Name

Phone *

(###)

###

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Nominee Information *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Areas They Serve (All That Apply) *

Functional/Root-Cause

Mental Health (Trauma - Informed)

Women's Health / Birth (OB, Midwife, Doula)

Massage/Bodywork

Physical Therapy/Movement

Personal Training

Farming (Livestock/Plants/Vegetables)

Natural Products/Apothecary

Other

Community Standards & Consent *

Bayou Wellness Collective uplifts those who are ethical and committed to wellness. Nominations are reviewed for alignment with our standards.

I confirm the information I’m sharing is accurate to the best of my knowledge and aligns with the spirit of the Collective. It is okay to contact me for follow-up or verification.