Advanced Workshop application

Returning students to our trainings please complete Part 1; new students please complete Parts 1 and 2.

PART 1


Name *

PART 1


Name
Address *
Address
Phone *
Phone
Married, partner, children, etc.
Instructor/Institution - Completion Date
Course - Length of Course - Hours of Tuition
Course - Length of Course - Hours of Tuition
Course - Length of Course - Hours of Tuition
(e.g., association registration, etc.)
Years in practice, number of clients per week, specialties, etc.
Prescribed and recreational drugs, including alcohol, amount per week
Physical illnesses, accidents, falls, etc.
Psychiatric, psychological processes that affected your functioning or well being
For physical or psychological reasons
Any known details, any relevant history
Your experience as a client to date, approximate number of sessions taken, any experience of Biodynamic Craniosacral Therapy? etc.