Register for Awakening the Third Eye workshop
Answers to each of these questions are required so we can provide a safe and open environment for all of our participants. We'd also like to get to know you a bit so we can best gear the content of the workshop to your specific needs. All information will be kept confidential.
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Type your full name below, and include a preferred name if it is different.

 
What is your current address?

 
What is the best phone number to reach you on?

 
What is your current occupation?

 
Please share your date, place and time of your birth and how it is known (eg. birth certificate).

We will look at your astrological chart before the course, to see if we can offer any relevant insights
 
Which email should we use to contact you?

Don't worry, we will not spam you
 
How did you hear about the workshop?

 
History: significant accidents, illnesses, surgery (particularly abdominal), hospitalizations, pregnancies, abortions, life events, etc.

 
Do you have any psychiatric history? ie hospitalizations or medications? past or present. If yes, please share more information.

 
Please list all prescription medication and/or supplements currently taken and the reason for taking.

 
Do you smoke cigarettes? If yes, roughly how much?

 
Do you drink alcohol? If yes, roughly how much?

 
Do you take recreational drugs? If yes, share what you take and how frequently

 
Please share a history of any other forms of spiritual work you have been involved with.

 
Please share a bit about your reason for taking the Awakening the Third Eye Workshop.

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