Name
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First Name
Last Name
Email
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Phone
(###)
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Select which applies to you:
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(note: 'symptoms' includes physical + emotional/mental)
Please briefly share any detail you're comfortable with based on your above selection:
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(i.e. nature of symptoms, how long you've experienced, etc)
What types of remedies/therapies/modalities have you tried to support, relieve or heal your symptoms/issues? Select all that apply:
How connected do you feel to your body at any given time?
Another way to ask: how often are you actually living in your body?
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Sometimes connected
Only connected when something isn't right/I am forced to pay attention
Dissociated; body is a separate entity
Body is a total mystery to me
This piggybacks onto the previous question: What is your current level of trust with your Body?
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Do not trust
Sometimes trust
Unsure
Strong trust (you likely don't need to be here!)
Tell me why you are interested in this course/work? (and a little about you too!)
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How did you hear about me?
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Instagram
Referral
Business card drop
Other
This is a beta version of the course at a third of the cost. I am looking for individuals who are open and invested in participating, along with providing feedback. The duration is 6 months and there are 3 calls each month. My goal is for your experience is to be rich and robust and also very spacious (aka let things have time + space to land). Are you willing to fully commit to this?
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