HEARTFIRE Intensives Application

HEARTFIRE Intensives Application
Name

First NameLast Name
Pronouns
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
What is drawing you to the Heartfire experience? What aspects do you feel would be helpful in your journey?
Share with me a bit about why you think this would be a good fit for you:
Share a little bit about your previous therapy/mental health work:
Are you local to Vancouver BC or willing to travel here for the experience?
Thank you for your answers and for taking the time to fill out this short form! Our next step will be to book a screening appointment to go more in depth on what you are wanting out of this experience. This form gives me a good idea if you would be an ideal fit for this intensive, as I want to make sure that it is the right step for you and I to go down together!

I will be in contact via email with any further questions I have and/or a booking link to schedule our intake session.

Chat soon!

-Nikki
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