Anemoni Advanced StaysPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 3 a extra way SummaryGenerally, Anemoni does not accept requests to plan a future stay. This is because Anemoni supports are primarily meant for trans and queer people who are trying to navigate emotional distress, problems with substances, etc. in the moment.However, one room will be prioritized for people who are also going to be coming out of Gender Affirming Surgeries and needing recovery space.PLEASE NOTE: We are required by our primary funder (the Massachusetts Department of Mental Health) to fill out ‘enrollment forms’ for people who stay at Anemoni House. A few of the questions on this form are based on that form. Anything we will be required to put on an enrollment form is marked with **. This information will only be sheared when/if you do stay at Anemoni House.Information about whether or not people staying at Anemoni House have recently had Gender Affirming Surgery will not routinely be disclosed to DMH. The reason for staying at the house will typically be listed as:“Intervention and support to manage symptoms and stressors”This is language from their form and will be the best applicable option for all stays at Anemoni House.We do not check IDs, so (for example) you can list a chosen or nick name rather than what’s on your ID or other legal paperwork and so on. If you are not comfortable providing required information, you can mark it with ‘N/A’. You are not limited to any particular choices when answering these questions. For example, for gender, you are not limited to specific choices and can put exactly what is true for you.This form is meant for people who need that post-recovery space.Name (Chosen name, does not need to match ID) ** *Gender ** *Pronouns you want us to use for youRace ** *Ethnicity ** *Date of Birth ** *Preferred Language ** *EnglishSpanishAmerican Sign LanguageOtherPhone Number (If you do not have a phone, put all 555's) *My phone: *Accepts phone callsAccepts textsAccepts calls AND textsN/A – I don’t have a phoneCan we leave a detailed message? *Yes, you can leave details in a message.No, you can leave a message, but no details please.Please do not leave a message at all.N/A – I don’t have a phone.Email (If you don't have an e-mail, use noemail@noemail.com) *What is the best way to reach you? *Text my phoneCall my phoneE-mail meAny of the abovePlease confirm that your request is related to Gender Affirming Surgery *Yes, I confirm that I will be having Gender Affirming SurgeryNo, I’m not having Gender Affirming Surgery, but I think my situation may still apply.My reason for requesting to plan a stay in advance is totally unrelated to gender or gender affirming care.There are a couple of other requirements for being considered for a stay at Anemoni House. They include:You are living or staying in MassachusettsYou are 18 years or olderYou are not registered as a Leve 3 sex offenderDo you meet all three of the requirements listed above? *Yes, I am living/staying in MA AND I am 18+ AND I am NOT registered as a Level 3 sex offenderI meet all the requirements above EXCEPT I do not live in MA. However, I live just over the border and would still like to be considered.I do not meet one or more of these requirements.NextUnfortunately, we are only able to consider scheduling stays in advance for people who will be recovering from Gender Affirming Surgeries and who are living in/staying in Massaschusetts and meet the other requirements listed.If you feel you’ve reached this message in error, you can call the house directly.Thank you! Now we have just a few more questions about dates and your anticipated needs during your stay.NextWhen is your surgery date? *What is your best estimate of when you would come to stay at Anemoni after your surgery? *Typical stays at Anemoni House are about 2 weeks long. Do you think that will work for you? *I think I’ll need less than 2 weeks.2 weeks is about the right amount of time.I think I may need longer than 2 weeks.What specific needs do you anticipate having during your stay? (e.g., Will be in a wheelchair/wheelchair accessible, extra support making meals, etc.) *Anything else you want us to know?Anemoni’s Director or Assistant Director will typically be the one to review ‘Advanced Stay Requests’ and get back to you.Please give us up to 72 hours to get back to you. If it has been longer than that, you can call the house directly and follow up.Submit