The Art of Deep Listening
Home
About
Updates
Contact
Intake Form
Playshops & Trainings
Home
About
Updates
Contact
Intake Form
Playshops & Trainings
Search by typing & pressing enter
YOUR CART
WOMB SURROUND PROCESS workshop INFORMATION form
We recommend reading through each question prior to filling out the application. Some questions may prompt you to research information; and/or contemplate what resonates the most for a response.
YOUR RESPONSES WILL ONLY BE VIEWED BY ALIYAH HAMILTON, AND WILL BE KEPT CONFIDENTIAL
*
Indicates required field
Which Workshop and Date are You Applying For?
*
Name
*
Birthdate
*
Email Address
*
Primary Phone #
*
Home Address
*
Mailing Address
*
If different from home address
Relationship Status
*
Married
Partnered
Single
Divorced
Widowed
What is your intention in exploring your prenatal and birth experiences?
*
Professional Information
If you are a bodyworker, psychotherapist, health care practitioner or student in these fields, please indicate the nature of your practice or extent of training (types of therapy). If you do not work in the “healing” arts please give a short account of the work you do.
*
Prenatal and birth therapy information
Note: Many of the following questions are intensely personal. Your responses will be kept completely confidential. Filling out this information form actually begins the work of the process workshop. If you are uncomfortable about responding to any of the questions please email or telephone me to discuss this.
Do You Have Children?
*
If yes, is there something you would like me to know about their prenatal or birth times?
Some of the work may involve physical exertion. Do you have any medical conditions which would contraindicate involvement in this way?
*
If Yes, Please Explain
Do you have any area of your body which needs special consideration?
*
Are you presently taking any medications or drugs? (name of medication, for what condition?)
*
Submit