Application Form | Finding Your Medicine

First name

Last name

Email

Phone

How did you hear about me?

*If we’ve connected before—through a conversation, inquiry, or meeting—please let me know how

What draws you to the space?

*As in what made you decide to reach out?

What has your relationship with receiving been like – whether that is receiving help, receiving rest, or simply allowing yourself to have something?

*If you don’t have an answer to that yet — that is okay. The fact that you are filling this out is already an act of receiving. Just share whatever feels true right now.

The Everglow Resource Room Application Form

Miramichi, NB