Registration Form

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January 26, 2018

$225 paid by December 31, 2017 $250.00 Full tuition paid by January 26, 2018

Couples:$400.00 paid by December 31, 2018 Couples:$450.00 paid by January 26,2018

Please send your check to:
Phoenix Center for Healing, P.A.
14875 SW 238th St.
Homestead, FL 33032

Please answer the following questions:

Are you currently under the care of a mental health professional, i.e. Psychiatrist, Psychologist, Counselor, Therapist, etc.?

If so, are you currently taking medication for your mental health condition, i.e. anti-depressants, anti-anxiety, etc.

If so, please contact Aida and or Bob, to discuss the extent of your participation in the weekend.

I am eager to begin this next step in my growth, and I am committing to myself and to others in the group to complete this weekend.