Basic Details
First Name
*
Last Name
*
Email
*
example@example.com
Mobile Number
Please enter a valid phone number.
Format: (000) 000-0000.
Country
*
Please Select
Afghanistan
Albania
Algeria
Andorra
Angola
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Chile
China
Colombia
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Ethiopia
Finland
France
Georgia
Germany
Ghana
Greece
Guatemala
Honduras
Hungary
Iceland
India
Indonesia
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kenya
Kuwait
Latvia
Lithuania
Luxembourg
Malaysia
Mexico
Morocco
Netherlands
New Zealand
Nigeria
Norway
Pakistan
Peru
Philippines
Poland
Portugal
Qatar
Romania
Saudi Arabia
Singapore
Slovakia
South Africa
South Korea
Spain
Sweden
Switzerland
Thailand
Turkey
United Arab Emirates
United Kingdom
United States
Vietnam
Other
A few safety questions, so I can give you the best care.
Are you pregnant?
*
Yes
No
What trimester are you in?
Please Select
First
Second
Third
Are you taking any medication?
*
Yes
No
Please specify medication
Do you have any physical health conditions? (for example heart condition, high or low blood pressure, epilepsy, asthma, glaucoma)
*
Yes
No
Please specify health issues
Any injuries or recent surgeries?
*
Yes
No
Please specify injuries or recent surgeries
Have you been diagnosed with, or are you experiencing, any of the following? (tick all that apply)
*
Anxiety
Depression
PTSD or trauma
Eating disorder
Substance use
Self-harm
None of these
What is your current hurdle or struggle? How does it manifest?
*
About you
What is your ideal outcome? What would you love to feel or achieve through this course?
*
What tends to get in the way of you practising or feeling your best?
*
Consent and Payment
Consent to course purpose
*
I understand this course is education and practice for nervous system regulation. It works alongside therapy and medical care, and does not replace them.
Payment for The Regulated Woman, 4 week course
*
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The Regulated Woman, 4 week course
Founding price
$197.00 AUD
$
197.00
AUD
Continue to secure payment →
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