Application for Support Program Posted on March 17, 2019June 21, 2019 by Carolyn James-Pytel Were you asked to stop & exit the application? No worries . . . Click Here Apply Online *Name*Email*10-Digit Contact Number (ex. 2223334444)*Best Time to Call*Do you have a chronic condition or illness that you would like to heal? (As a way to break negative identifications, from here on out, any condition or illness will be referred to as wellness. ) Yes No *Is your primary form of treatment is alternative to Western Medicine, meaning you are mostly going the holistic route, but may be incorporating some traditional aspects, such as medication, chemotherapy, etc.? Yes No *Have you committed to a form of healing? If no, stop here and click on the link at the top of this interview page. Yes No - Stop Here & Click on Link at the Top *Check the form(s) of healing you are using. acupuncture Alexander technique aromatherapy Ayurveda (Ayurvedic medicine) biofeedback biofield therapy chiropractic medicine diet therapy Emotional Freedom Technique (EFT) herbalism holistic nursing homeopathy hypnosis massage therapy meditation Dr Joe Dispenza meditations naturopathy nutritional therapy Osteopathic Manipulative Therapy (OMT) Qi gong reflexology Reiki spiritual healing Tai Chi Traditional Chinese Medicine (TCM) yoga crystal healing Quantum Healing Sound Vibrational & Frequency Healing If a form of healing that you are using was not listed, add it here.*How confident are you in your body's ability to heal itself? Not So Confident Fairly Confident Confident Very Confident *Have you been able to identify any teachings that your conditions holds for you? If so, what are they?*What is your biggest challenge that keeps you identifying as being a victim to your condition?*Often people know deep down what they have to change in order to heal, but they ignore it our of fear. If this the case for you, what do you need to change and what is holding you back?*What are you looking for in a support system?*Are you ready to let go of blame, anger, and fear, and start taking responsibility for all areas of your life? Yes No *Have you grieved for yourself long enough and are ready to move forward? Yes No *What is your greatest strength? Fields with (*) are required.