Essence Journey Application Form
The Essence Journey has been designed for those who are ready and willing to take a deep dive inward. There is therefore an extended application process to help asses if this intensive program is for you. 

To begin the process, please answer the questions below as honestly and authentically as possible. If any of the answers feel too personal to share in this form, I am happy to discuss your answers over Zoom, which is the second stage of the application process.

Once submitted, you will receive a response within 24 hours. 
I look forward to speaking with you.
Sign in to Google to save your progress. Learn more
Email *
Name *
How did you hear about the Essence Journey? *
In short, please share why you feel called to experience the Essence Journey.  *
In short, please share your intention(s). i.e. what are you ready to move through, process or release?  *
YOUR MENTAL HEALTH
On a scale of 1 to 10, how would you define your mental health? *
Unstable
Stable
Have you ever experienced or been diagnosed with any of the below? *
Required
Do you currently take or have you ever taken medications for any of the above disorders? *
Have you ever had suicidal thoughts? *
PRACTICAL INFORMATION
What dates would you ideally like to begin your Essence Journey? *
Which country, city/area would you like your Essence Journey to take place? *
Before submitting your application, please take a moment to read over the Essence Journey Agreements. *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms