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DIWS Membership Application
Building a TRIBE means meeting the needs of all our members. The information provided here will help me know how to provide our community with the best and most needed information.
Name *
Address *
EMAIL *
Phone number *
What types of relaxation practices have you tried? *
Required
What types of things are you interested in?
Anything else important for us to know?
I authorize, you to contact me and provide me with a complimentary telephone consult. I realize that this telephone consult does not replace formal therapy or professional nutritional advice. I am aware that I will be able to schedule follow up counseling/coaching and that these services may be reimbursed through my insurance carrier. *
Required
BY CHECKING THIS BOX BELOW YOU WOULD LIKE TO RECEIVE OUR DIWS NEWSLETTER OR SPECIALS *
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