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Sign Up as a Peer!
Filling this form
Verification call (once we review the form)
Profile creation on the website
Note: Due to the surge in number of Peer applications, there may be some delay between steps.
Full name
*
Date of Birth
*
Which of the following pronouns apply to you?
*
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She/Her
He/Him
They/Them
Other
Occupation
*
Please select your marital status
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Single
Married
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Separated
Widow/Widower
Do you have kids?
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Yes
No
What languages are you proficient in?
*
Please highlight 1 or more broad categories that apply to your key personal life experiences and which you are willing to discuss with callers.
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Relationships
Medical Issues/Care-giving experience
Interesting life choice
Mental health
Career
Loss/Grief
Family/Friends
Please DO NOT mention things that you have trouble displaying on a public profile
Please add your profile ( MINIMUM of 8-10 lines and upto 20 lines) which outlines key personal life experiences (Displayed on Vitality profile)
*
Do you consent to us sharing your profile (as seen on Vitality) on the following public forums, as per need? ( SELECT the ones you are okay with)
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LinkedIn
Instagram
Twitter
YouTube
Facebook
Which for the following slot types work for you to have Vitality Conversations.
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Weekday Morning
Weekday Midday
Weekday Evenings
Weekday Nights
Weekend Morning
Weekend Midday
Weekend Evenings
Weekend Nights
Please specify days AND time in the week that work for you to have SoulUp Conversations
*
Recommend that you ONLY provide slots that you are certain of being available for - upto a maximum of 1 slot per day.
Have your ever taken any of the following?
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Medication for a diagnosed mental health condition
Therapy
Psychiatric Consultation
None of These
Are you okay taking SoulUp calls with people of a different gender?
*
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Yes
No
Email Address
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(NOT displayed on Vitality profile. NOT shared with anyone.)
Phone
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(NOT displayed on Vitality profile. NOT shared with anyone. This is only to get in touch, not to send spam! )
City
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Select Education Level.
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Undergraduate (Bachelor Degree)
Graduate (Masters Degree)
Doctoral Degree
What college did you go to?
*
What company do you work for?
*
(NOT displayed on Vitality profile - we will use it to filter out anyone from your company in case they book a call with you)
Have you ever been diagnosed for any mental health condition that you may have mentioned in your profile
*
Select
Yes
No
How did you hear about SoulUp?
*
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LinkedIn
Instagram
Facebook
Twitter X
Friends/Family
Existing Peer
Team Reach Out to You
YouTube
Google Search
Please add a link to your Social Media Profile or any other public account (NOT displayed on Vitality profile)
LinkedIn
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