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Energetic Fertility Method™ (EFM) Practitioner Certification Program Application

Please complete the following questions so that I may get to know you and better assist you throughout the EFM Practitioner Certification Program. There is a "Save and continue later" option at the bottom of this page, if you want to come back and complete the application at a later time.

Energetic Fertility Method™ (EFM) Certification Training Program Application

Name
First Last
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date of Birth
MM slash DD slash YYYY
What's your current occupation?
Do you have a work-related website? If yes, what’s the URL?
Are you a healthcare professional?
- yes
- no
List any credentials, professional licenses and academic degrees that you hold.
List any certifications or trainings you've completed or attended that are relevant to your application to the EFM Certification Training Program.
What are your personal strengths, weaknesses, dreams and aspirations?
List 3-5 values that are important to you in your life. Provide specific examples of how you use each one in your daily living.
Why would you like to become certified in EFM?
Which complementary and alternative healthcare techniques have you tried? (Check all that apply)
- Acupuncture
- Alexander Technique
- Aromatherapy
- Ayurveda
- Biofeedback
- Chiropractic
- Craniosacral Therapy
- Herbalism
- Homeopathy
- Hypnosis
- Mayan abdominal massage
- Massage therapy
- Meditation
- Naturopathy
- Nutritional therapy
- Osteopathy
- Qi gong
- Reflexology
- Reiki
- Spiritual healing
- Tai chi
- Traditional Chinese Medicine (TCM)
- Yoga
- Other
Do you have a meditation practice?
Describe any training and/or study you've had in the area of spiritual growth.
Describe your current self-care practices.
What are you currently working on in your personal development?
Date
Month
Day
Year
Typing your name below will be considered your signature.
Phone
This field is for validation purposes and should be left unchanged.

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