Inner Child Healing Program Application - Spring 2024
A required form for anyone interested in participating in the program. This form is confidential and will not be shared with anyone except program Staff. With program Staff, this information will only be shared on a need-to-know basis.
Sign in to Google to save your progress. Learn more
Name *
Email address (This will only be used to email you to set up the required phone interview.) *
Birthdate *
MM
/
DD
/
YYYY
Today's Date *
MM
/
DD
/
YYYY
Pronouns
Tell us a little bit about yourself: *
Why are you interested in doing an Inner Child Healing Program at this time in your life?
 Please mark the stages of development during which you believe you had or may have had wounding experiences (these could be anything from very subtle to traumatic experiences/impressions, etc. ) *
Required
Which topics are ones with which you would like help? *
Required
Have you already had a phone interview with Alison? *
Please describe your recent and past history with psychotherapy and/or other psycho-spiritual healing activities.
Are you currently in therapy, or something similar to therapy, that you could utilize post-program for continued support of your healing process?
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms