Alaskan Essences
 

Practitioner Discount Research Program
Registration Form
 

Thank you for your interest in our Practitioner Discount Research Program. To be eligible for an ongoing discount of 15% on all of our products, you must:
  •Agree to submit two case histories yearly that involve any of the essences in our repertory.
  •Be willing to be contacted from time to time for additional research information.
To register for the program, please fill in and submit the form below. Your discount will go into effect once we have received and approved your application. Note: If you wish to use your discount with our On-line Store, you must create an account first.
 
Name  Date (mm/dd/yy)
Address
Phone      Fax
Email
 		   Web site
 
1. What kind of healing practice do you have?


2. How are vibrational essences used in your practice ? Are they the primary focus of your work, or do you use them to support other modalities?


 
3. What other healing modalities do you offer?


 

4. How long have you been using the Alaskan essences in your practice?
Flower     Gem      Environmental
 
5. What other ranges of essences are you using in your practice, and how long have you used them?


 
6. How do you select and administer essences to your clients?
7. Do you work with children in your practice? Yes    No
If so, for how long?
 
8. Do you work with animals in your practice? Yes    No
If so, for how long?
 
9. How do you currently keep records on your clients?


 
10. On average, how long do you work with a given client? 
 
11. Describe your essence related educational background, including certification programs given by other essence companies


 
12. Please use this additional space to provide any additional information about  yourself and your work with essences


 

        

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