Please send the completed application as a Word or PDF file to firstname.lastname@example.org.
City, State & Zip:
Phone, Skype, etc:
Previous Experience with PNE or Other Healing Modalities
Which practitioners have you worked with?
How many sessions have you had?
Which other types of therapies have you been involved with, as a client or practitioner?
Are you living some version of a regenerative lifestyle? (Please answer in detail.)
Do you have any active addictions that you’re struggling with?
Are you taking anti-depressants or other prescription medications?
Are you seeing a counselor or mental health professional on a regular basis?
What are your goals for the Practitioner Training Course?
Why do you want to pursue this training?
Is there any information that is important for us to know about you that could affect your participation in this training?
Judith Johnson, (919) 245-8082 (home), (828) 773-3445 (cell), email@example.com
Sieglinde Hieronymus, +49 8368 266 434, firstname.lastname@example.org