Mother Hunger® Retreat Interest
To help Emily better understand where you're at with your healing work, we'd love to know a bit more about you. Please complete the form below and we'll be in touch to discuss scheduling a one-on-one free Zoom consultation call directly with Emily Grimes, Mother Hunger® Trained Facilitator. Thank you!
We'll never share or sell this information. 
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Your Name *
Your Date of Birth *
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Your Location (State/Country)  *
Your Email Address *
Your Phone Number  *
How do you prefer we contact you?  *
Have you read the book Mother Hunger® by Kelly McDaniel?  *
Do you identify with the term 'third degree Mother Hunger®'? (This term is defined as the attachment figure in your life not being a source of safety, but instead a source of danger and fear, often accompanied by physical threat or harm.)
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Are you currently in therapy or working with a life coach?  *
What work (if any) have you done in regards to the Mother Hunger® wound?  *
Why do you want to participate in a retreat?  *
In a few sentences, what is your current relationship with your Mother like?  *
Is there anything else you'd like Emily to know? 
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