Congratulations!

You have taken the first step toward embracing change head on and using growth to your advantage.

Over the next 8-12 weeks, you will:

  • Adopt a new understanding of your subconscious and self
  • Learn how to easily identify sources of pain and discomfort
  • Learn how to lessen and/or eliminate those sources
  • Gain powerful, life-altering life skills and tools to help you navigate the life you want for yourself
  • Learn how to apply the new skills in a get-right-down-to-it method
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Email *
First, we need some basic information
Incomplete information will result in your application being declined. 
Legal First and Last Name *
Preferred Name
Phone number (format: 212-555-1234) *
Which contact method is best for you?
*
Required
Now we need to know a little about you and your current situation
The Healing Garden implements Meditation and strongly encourages and refers Reiki Healing, Yoga, Pranayama Meditation, and Tai Chi. Although The Healing Garden Masterclass can be completed without these practices, it does significantly limit the full Healing Garden experience.

What is your current situation that brings you to the Healing Garden?

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What is your biggest source of stress?
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Self-Care Regimen
Anna uses Astrology and Human Design to build your Self-Care Regimen. For this reason, she requires as much of the following information as you can provide.
Birth Date *
MM
/
DD
/
YYYY
Birth Location *
Birth Time. Be as precise as possible. If you do not have the time, don't worry about it.  *
Do you suspect your parents of being Narcissists? Select all that apply *
Required
What is your Birth Order? *
Do you come from a Christian/religious home? Was either Parent/Guardian forceful or strict on making sure you embrace their religion?
Coping Styles
We all have Coping Styles. We need to determine yours. You are either a Controller, an Avoider, or both. an easy way to determine this is if you know your Attachment Style. 
What is your Attachment Style
Clear selection
Have you ever suffered from Addiction?
Clear selection
Emotional Balance and Health
These next few questions help me determine what you are dealing with. Please rate each emotion on a scale of 1 to 5. 1 = Not at all. 5 = Constant and loud. 
Fear *
Almost none
It's constant and is loud.
Anxiety *
Almost none
It's constant and is loud.
Guilt *
Almost none
It's constant and is loud.
Depression *
Almost none
It's constant and is loud.
Emotional Pain and Suffering.
Almost none
It's constant and is loud.
Clear selection
Suicide and Self-Harm
Due to the sensitivity and gentle requirements of suicide, Anna will not work with clients who are currently battling suicide and self-harm. The Healing Garden is simply not yet equipped or staffed to handle those who are contemplating suicide. 

If you are currently struggling with suicidal thoughts or urges, please contact your health care provider immediately or go to the Emergency Room. 

You may still continue filling out this form. Anna will still follow up with you. If you need assistance or guidance getting you to the right health-care professional, we can help.
Are you currently thinking about suicide or hurting yourself? *
Do you require emotional support to help you seek professional help for suicidal ideation? *
Seeking Help with Suicide
If you need help with suicide, Anna will walk you through the process, who to speak to and what you can expect so you won't be alone through the process. It can feel intimidating and scary. Still fill out the form, and she will be in touch with you shortly. 
Tell me about your parents growing up.  
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What motivated you to reach out to The Healing Garden?  *
What changes do you want to see more than anything after you complete the 8-12 week course? *

How is your current situation holding you back in life, both professionally and personally?

 *

After these steps are complete, what changes do you want to see more than anything?

 *
What is the biggest obstacle right now that prevents you from getting what you want?
*
Please take this space to tell Anna anything else you would like to say -- anything else you feel she needs to know about you. 
How committed to you are this?
The Healing Garden is for people who are serious about their healing, who are ready to take an active role in their healing. This is not quick advice, you must be ready to fully commit to a process that will take time. The Healing Garden is for those who are ready to eat, sleep, and breathe this lifestyle. It is for people who crave and desire the change more than they hate the work, more than they fear the change ahead.  
Right now, I…
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Do you promise to show up for your scheduled appointment ON TIME and DISTRACTION FREE? Please confirm by typing “Yes, I will” in the box below.
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Finally, on a scale of 1 to Chuck Norris… how awesome are you?
 *
Eh. I'm not impressed with me at all.
Chuck Norris
A copy of your responses will be emailed to the address you provided.
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