auf Deutsch

Treating Healthcare Professional Form

Full Name of Healthcare Professional *
E-Mail of Healthcare Professional *
Please select the relevant Path of Love *
Full Name of Path of Love Applicant: *
E-Mail of Path of Love Applicant *
Please provide the address and phone number of your practice below.
Address *
Suburb/City/Town *
State/Province/Terr/Region
Postal/Zip Code *
Country *
Phone Number (Home) *
Phone Number (Mobile) *
Please share your credentials, thank you.
Is there anything you would like to share about the POL applicant (your client) that may be helpful for our workshop Facilitators and therefore beneficial for your clients well-being and retreat process? *
* I certify that I am the psychotherapist/psychiatrist/psychologist or other healthcare professional currently caring for the individual named above. I have read the Path Retreats Guidelines for Professionals, and (if I felt it was appropriate and/or needed) consulted with a Path Retreats Organizer or Facilitator. Assuming the truth and accuracy of all of the information provided to me about the program, and my professional experience working with the individual named above, my signature below verifies that the individual named above has the mental and emotional stability to participate in the Path of Love 7-Day Retreat.

Signature

(Please type your full name in the box): *

Weekly Wisdom.

Sign up for Path Retreats Weekly Wisdom and begin your week with inspiration!

Schedule a call with one of our Retreat Advisors to learn more about the Path of Love 7-Day Retreat.

This link will take you to an external site, where you can share your contact information (such as e-mail and/or Skype Name, etc.) and schedule an informal chat with one of our Retreat Advisors.

We place cookies on your computer to ensure you receive the best browsing experience possible. By using our website, you agree to our use of cookies as described in our Cookie Policy.