RAHI Firebird Healing Workshop - Participant Form
Thank you for filling this form. We understand that we are asking you for sensitive information. We are doing so because it will help us understand you and your healing needs better. The information you provide will be strictly confidential and read only by the RAHI counsellors.
Email address *
Name *
Mobile Number *
Date of Birth *
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City *
Occupation *
Relationship Status *
Number of members in your family of origin (please specify who all are there and where you are in the sibling order): *
Number of members in your current family *
Is there any history of violence, abuse, alcoholism or mental illness in your family? If yes, please tell us about it briefly *
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