Evergreen Healing Program
Holy Spirit-led Nervous System healing program for women ready to break free from dysregulation and step into a thriving abundant life.
Email *
Name *
First and last name
Phone Number *
Birthday *
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Have you gone through any therapy, counseling, inner healing, life coaching, or deliverance ministry etc.

If yes, give a brief summary of your experience positive and negative.
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Healing is a commitment physically, emotionally, mentally, and financially. Which of the following best describes your personal finances? (Please answer truthfully, as this is a huge part of determining the advice we give you.) * *
Current marital status *
Have you ever been separated/divorced? YES/NO
Please provide an explanation of each marriage and separation and/or divorce
 *
Do you have children? *
How much do you know about nervous system regulation and spiritual freedom, and what do you do to support your nervous system currently?  *
Do you have any illnesses? 
Please list and describe them
 *
Have you received treatment for any diagnosed physical, emotional or mental conditions in the last 5 years? Please list them  *
Have you ever been involved in the occult, witchcraft, or cults? Please explain *
Have you exhibited any self-destructive behavior or habitual problems with the last 5 years? (i.e. eating disorder, cutting, compulsive lying, etc.) Please explain *
Please give a brief description of your Christian journey (i.e. how you came to know the Lord; your present walk with the Lord). *
How did you hear about The Evergreen Healing Program *
Briefly explain why you want to join Evergreen Healing Program *
What are you passionate about?  *
What do you hope to do with the things you learn going through Evergreen Healing Program? *
What are your current emotional health/ nervous system struggles? *
How often do you feel overwhelmed? *
What close relationships would you seek to improve? *
What days and times would you be available for a discovery call to go over your application to see if you'd be a good fit? *
Anything else our team should know as we review your application? *
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