Name *

First Name

Last Name

Phone (if you're open to actually talking)

(###)

###

####

Name *

First Name

Last Name

What is your experience so far with ancestral lineage healing?

please check all that apply

None, I am new to this way of working

I have reading about Ancestral Medicine

I have participated in/am participating in an Ancestral Medicine online course

I have had private session(s) with a practitioner

I have attended an ancestral lineage healing intensive

I understand that my responses will be shared with select ancestral healing practitioners or trainees and that by responding here I give my permission to be contacted to arrange for sessions. *

I understand and agree

I understand that I may be placed with either a practitioner or a practitioner-in-training from the Ancestral Medicine Practitioner Network. *

I understand and agree.