• Soham - Immersive Healing Program

    Registration form cum case record

  • Please Note:
    On registering to the workshop, our team will review your form along with case record and update you on the status of your acceptance into the program over email within a week along with the room payment link as per your choice of room and the payment link for the Workshop.

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  • English Proficiency*

  • Lifestyle Information

  • What is the activity level at your work?*
  • Do you follow a regular working schedule; do you work days, afternoon or nights?*
  • How often do you travel?*
  • How comfortable are you with understanding the English language?*

  • Medical Information

  • Do you have any stress or reason for lack of motivation?*
  • Have any of your immediate family members developed heart disease before the age of 60?*
  • Do any diseases run in your family*
  • Do you suffer from diabetes, asthma, high or low blood pressure?*
  • Do you smoke?*
  • Your current diet could be best categorised as:*
  • Should be Empty: