Guest Application

1

Which of these best describes your goal here?* This field is required.

I'm here to improve my health.

I'm a healthcare professional interested in mentorship and advanced clinical training.

2

As of today, which best describes your attitude towards healing?* This field is required.

I am open and ready for new health solutions and I believe there is a way for me to get better.

I am jaded and burned out from trying and failing, but still cautiously optimistic that there is help and hope.

I'm just here to learn more.

3

How much are your symptoms interfering with you life?* This field is required.

My symptoms interfere significantly but I still push through to have the fullest life possible.

My symptoms interfere significantly and I've given up doing so many things that I enjoy.

My symptoms are mild and rarely interfere with my life.

4

What is your age?* This field is required.You must be 18 or over to join our group. If under 18, your parent/guardian may apply on your behalf.

18-30

31-40

41-50

51-60

61-70

71+

5

What is your name?* This field is required.

First Name

Last Name

6

What is your phone number?* This field is required. So we can recognize and correctly add you in our chat group. We will not contact you for any other reason. If you're outside the US you must include your country code.

Country Code

Area Code

Phone Number

7

Your Favorite Email Address?* This field is required.So we can let you know your application status via email (we will not add you to any mailing lists or contact you for any other reason.)

example@example.com

8

What country/nation do you live in?* This field is required.

9

What do you do for a living?* This field is required.Or, if retired, what was your most recent career?

10

How did you discover Shelley / Living Alchemy?* This field is required.Was there a specific video or post that resonated with you and made you want to apply? What was the title or topic?

12

What are the top 1-3 things you'd like help with regarding your health?* This field is required.What are your most difficult symptoms? Do you have any diagnosis? What are your health goals? Please be as detailed and specific as possible. (You're over halfway through the application now.)

13

Please list everything you've tried in the past to improve your health. Approximately how much did each cost?* This field is required.Practitioners, Programs, Courses, Retreats, Supplements, Products, etc If you're having problems clicking "Next" and using a mobile device, write your answers and then gently swipe up and then click the next arrow for the next question.

14

What are some of your biggest challenges to healing right now?* This field is required.What's blocking you from getting better? (only 5 questions left)

15

Please share something you believe to be true about your current health situation that may be controversial or that others don't necessarily understand.* This field is required.Be as detailed and specific as possible.

16

When you hear about something unusual that you've never thought of before, do you:* This field is required.

Immediately dismiss it

Ask for scientific data

Get excited to try it / test it yourself

Survey trusted people and advisors

Listen to your gut response about it

17

Have you ever had any unusual healing experiences that don't fit inside the conventionally accepted model of health / life / and how things should be?* This field is required.Please explain a little and share how you handled them.

18

If we were sitting down and talking a year from now, what would have needed to change for you to feel successful with your health?* This field is required.Be as detailed and specific as possible. If you're having problems clicking "Next" and using a mobile device, write your answers and then gently swipe up and then click the next arrow for the next question.

19

If we could wave a magic wand and give you only one wish, which would you choose?* This field is required.

I would wish for all my symptoms to go away for 1 year and then return as they were.

I would wish for my symptoms to reduce by 50% and stay that way for the rest of my life.

20

Why did you choose that specific answer?* This field is required.Be as detailed as possible. If you're having problems clicking "Next" and using a mobile device, write your answers and then gently swipe up and then click the next arrow for the next question.

21

Lastly, are there any unique factors we should know about your case while considering your application?* This field is required.If you're having problems clicking "Next" and using a mobile device, write your answers and then gently swipe up and then click the next arrow for the next question.