RegistrationConstellations

Registration Form – Family Constellations Workshop:
  * required field
First Name: *
Last Name: *
Gender:
Age:
Occupation:
Mobile Phone: *
Email: *
Email confirm: *
Suburb:
State:
Country:
Asthma:
Have you ever been diagnosed
with any mental health issues
(eg. Schizophrenia, Psychosis,
Clinical Depression, Bi-polar
Disorder, etc)?
Please state the nature
of the issue in your
own words:
YOUR DESIRED OUTCOME FOR THERAPY:
(How would you like to feel/behave/see yourself at the end of successful therapy?
What would you like to achieve?)
Have you been to Family Constellations workshops before?:
This is a group workshop, and you are required to maintain confidentiality regarding any information shared by the other participants. Do you agree to this?:
Participation and Pricing Level:
$350AUD – Personal constellation is facilitated 
$FREE – Participating as resonator/representative – active participation, highly insightful and unique experience (12 spots in each workshop):
Which workshop (enter date)?:
After the workshop I offer a free follow up. What is your preferred method of follow up/feedback?
How did you find me?
Can I add you to my mailing
list for updates?
 
Terms and Conditions
Please read carefully
1. Family Constellations Workshops can be an emotionally stimulating experience. It may be unsuitable as a therapy for people with certain mental health conditions such as schizophrenia and bi-polar disorder. People with such conditions must discuss it with the therapist PRIOR to any therapy, especially in a group setting.
2. The number of participants for the Family Constellations Workshops is limited. There will be no refund for cancellations made less than a week prior to the workshop.
3. I consent to Therapy with Yael Reiss and understand that this therapy should never be used as a substitute for medical treatment.
4. After your registration form is received you’ll receive an email with payment details by bank transfer.
5. No guarantees are offered.
  I have read and understand the above Terms and Conditions.