The Ultimate Healer Intake Form

1

What's your name?* This field is required.

First Name

Last Name

2

What's your email?* This field is required.

example@example.com

3

What's your Instagram handle?* This field is required.

4

Tell me about where you are in your healing journey. What healing work have you done in your journey so far? Any healing modalities, therapy, or work you've done, let me know! * This field is required.

5

Why do you feel called to become a healer?* This field is required.

6

What drew you to this program? What lights you up about it? What are you most excited to learn? Why Leyla as your mentor?* This field is required.

7

This program will require you to heal layers of yourself, look at yourself deeply, and time per week to practice your skills you're learning in class & in online modules. Are you ready to commit the time, space, energy and time into healing yourself with us, learning, and watching online modules & practicing live with us?* This field is required.

YESNO

8

When you become a healer, who do you want to work with or help?* This field is required.

9

What would your healing practice look like after a year working with me?* This field is required.

10

This school is not a traditional school. It is a place to explore, play, learn, and practice the healing modalities so they become like you, in your style. Are you okay with this and willing to self lead yourself?* This field is required.

YESNO

11

When we have determined we are an energetic fit, which payment option would you like to go with?* This field is required.

$7,777 USD Pay in Full

$4,138.50 USD x 2 months

$2851.33 USD x 3 months

Klarna Payment of $373.36 per month

Affirm Pay of $269.59 per month

12

Is there anything else you want me to know?