Application

Thank you for your interest in a Visit for Your Self with Victor and Steven. We are honored that you’re interested in submitting an application. Receiving your answers will help us determine how we can best help you and appropriate next steps, which may include a 20-30 minute phone or video call.

A Visit is $500 for one person or $750 for a couple for an 8-hour day. Partial scholarships may be available.

Every Visit for Your Self is focused exclusively on you. If you will be travelling from out of town, you may find this information helpful in planning your visit.

Please fill out the form below and we will contact you. Thank you.

Name *

First

Last

Email *

Phone Number

Phone type

• Cell
• Home
• Work

Modalities of Interest (Check all that apply) *

• Astrology
• Bodywork (Reiki, reflexology, etc.)
• Soundbath (Singing bowls, gong, etc.)
• Tai Chi
• Meditation
• Dreamwork
• Other (Describe below)

Other Modalities of Interest

What has led you to seek a Visit for Your Self?

Describe the help you have sought in the past

all the Self?

Share your successes and/or disappointments with the help you previously sought

What are you hoping to receive from a Visit for Your Self?

Additional comments or questions

Submit Application