Program Registration | Self Healing Expert

First name

Last name

Email

Location & country code

WhatsApp Number (inc country code)

What Program Package Would You like

Core Program only

Full Program

Unsure

Which payment option do you prefer?

Pay in full & upfront (Best Value)

Payment Plan (Accessible option)

Undecided

I'd like to discuss an alternative option

Do you need to discuss alternative financial solutions to make this program affordable &/or accessible for you?

Yes

No

Unsure

Are you interested in having private 1-1 sessions during the program?

Yes

No

Unsure

Please give a general overview of what you hope this program will help you overcome

If you selected 'None of the above' please detail below the days & times when you're regularly available. (e.g mondays 8- 11am)

Is there anything else you would like to share with me at this time?

I confirm that I was born female & identify as an woman/ adult female. (please note - these are prerequisites to joining this group container to ensure that all participants feel comfortable, safe & seen)

I am joining this program because I have experienced & want to heal & recover from some form of sexual trauma. (please note - this is a prerequisite to joining this group container, as the content & focus will be based around this work)

I understand that through submitting this form & paying the deposit I am commiting to particpating in this group container. I understand and agree to the following: That my deposit is not refundable unless 50% or more of the group coaching sessions do not align with the availability that I disclosed in the questions within this form.

To complete your registration & secure your place on the program you will need to pay a deposit of:

£88

Once you hit the submit button, you will be redirected to a secure payment page for you to pay your deposit & complete your registration.

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info.selfhealingexpert@gmail.com

SELF HEALING EXPERT

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Group Program Registration