Full Name
*
Email
*
Phone
*
Are you a spiritual woman over the age of 50?
*
Yes
No
On a scale of 1 to 10, how familiar are you with mindfulness practices?
*
What are some of the biggest challenges you are facing right now in regards to your recovery from your concussion/traumatic brain injury?
*
Choose all that apply
Memory loss and difficulty with focus and concentration.
Fatigue and low energy levels.
Sensitivity to noise, light, or other sensory stimuli.
Emotional instability, mood swings, or irritability.
Difficulty with balance, coordination, or mobility.
Anxiety or depression related to the injury.
No elements found. Consider changing the search query.
List is empty.
What kind of support or resources are you currently utilizing to aid in your healing process?
*
Choose all that apply
Support groups
Yoga
Meditation
Sound therapy
Other
No elements found. Consider changing the search query.
List is empty.
How important is it for you to have a sense of community and connection with others who are on a similar path of healing & self-discovery?
*
Connecting with others on a similar path is crucial for me.
Feeling a sense of community and support is very important to me on my healing journey.
I value my independence, but connecting with others on a similar path is still somewhat important to me.
I'm interested in learning more about the benefits of connecting with others on a similar path.
I'm still figuring out what I need on my healing journey, but I'm open to the idea of connecting with others who are on a similar path
Ideally, when would you like to begin this program?
*
Select an option
I am ready to begin now.
I am interested but need more information before deciding
I am not sure if this program is right for me at this time
No elements found. Consider changing the search query.
List is empty.
Submit