Womb Hara Application Form

Name

Email Address

Home Address

Location of Training Location of TrainingAustraliaManchester, UKGlastonbury, UKNetherlandsUSACanadaBali

Date of Birth

Phone Number

How did you hear about Integrative Womb Hara Massage?

What does your womb space mean to you?

Have you had any prior massage or bodywork training? Please list all qualifications below:

Have you had any anatomy and physiology training?

Have you ever experienced womb trauma or abuse?

Are you on any medications? Please list them below:

What are you most excited about this training?

Is there any topics you would like covered in the course?

Does your womb wish to add anything to this application? (sit quietly for a moment and place your hands on your womb and ask…)