Akili Sawa Reconnection & Grief Support Form

Home Akili Sawa Reconnection & Grief Support Form

Personal Information

Plan Details

I wish to register for the Reconnection & Grief Support Plan (KES 7,000)

Preferred Session Format

In-person (where available)Video callChat (App/WhatsApp)Mixed

Preferred Language

EnglishSwahili

Brief Background (optional)

Payment Options

Mobile Money (M-Pesa / Airtel Money)Bank TransferCorporate or Sponsored Payment

Payment instructions will be shared upon form submission.

Consent & Agreement

I agree to the terms of service and privacy policy of Akili Sawa.

I understand this plan includes two therapy sessions and cultural therapist support for grief and reconnection. Find our banking details here.

651 N Broad St, Suite 201, Middletown, New Castle, Delaware.

Strathmore University, Ole Sangale Rd, Nairobi

Personal Information

Subscription Details

I would like to subscribe to the Annual Therapy Plan (KES 11,200)

Preferred Mode of Sessions: In-AppChatVideo CallMixed

Payment Options

Mobile Money (M-Pesa / Airtel Money)Bank TransferCorporate Account (if employer-sponsored)

Instructions will be shared upon form submission.

Consent & Agreement

I agree to the terms of service and privacy policy of Akili Sawa.

I understand this is an annual subscription at KES 11,200, renewable every 12 months unless cancelled. Find our banking details here.