Warren Grossman, The Healer

Date
Name
Address
Day Phone: Evening: Cell:
Email
Degrees/Training (Please list the schools and years of graduation or certification):
Nature of healing practice (if any):
How long have you been practicing?
If you are not currenty practicing a form of healing, how might you use this work in your life?
What are some of the ways you gain self-knowledge? (pyschotherapy, meditation, yoga, etc.):
How did you hear about The Warren Grossman School of Healing?
Have you taken a workshop with Warren before?
	When? Where?
Why would you like to attend The Warren Grossman School of Healing?

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