The Complete Chakra Experience
Event Timing: October 14th, 15th and 16th, 2022
Event Address: White Oaks Resort & Spa (253 Taylor Rd, Niagara-on-the-Lake, ON L0S 1J0)
Contact: Heidi Martin @905-515-7925 or heidimartinwellness@gmail.com
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Emergency Contact Name and Phone Number
How did you hear about us?
Personal Information
Please note that the information you provide in this section is strictly confidential!
What type of healing work have you done previously?
Are you certified or licensed in some type of individual work (e.g. holistic practitioner, therapist, Reiki practitioner etc.)?
What do you love about yourself?
What changes would  you like to make in your life?
Describe any challenge in your life right now (i.e., health, career, relationship). How are you working with it?
Are you currently in therapy or have you been in therapy?  If yes, please explain.
Are you on any medications? If yes, please list them.
What sex do you identify with?
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Do you have any special needs for a physical challenge? If yes, please explain.
Payment schedule: Course fee: 1,197.00 plus HST (includes breakfast, lunch and coffee / tea station throughout the day).  A deposit of 500.00 is required upon registration and to reserve your spot.  This deposit is non refundable.  Balance is due by Aug 22nd, 2022.Please check one of the following methods of payment:
Please check one of the following methods of payment:
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