Application

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

Each Visit for Your Self is an 8-hour day focused exclusively on an individual or members of an immediate family. 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

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

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

Number of People *

• Individual
• A couple
• Family of 2
• Family of 3
• Family of 4
• Family of more than 4

Additional person

Relationship to you

Phone you

Additional person

Relationship to you

Additional person

Relationship to you

If you selected more than one person, what would you like to explore together?

Additional comments or questions

Submit Application