Certified Birth Healing Practitioner Application

Certification Application

Thank you for your interest in becoming a Certified Birth Healing Practitioner! I am honored that you have decided to take your skills and training to the highest level to help pregnant and postpartum clients and be part of the Birth Healing Movement!

Please fill out the application below in its entirety. As a note, these questions are designed to gain a better understanding of your experience, the support you may need, and the tools that will best help you achieve your goal of certification. Please answer these questions to the best of your ability.

Next Steps After Completing This Application:

You will receive an email in follow up from me directly after I review your application (usually within 2 weeks or less from the time you apply).
You will receive the link for payment of the Certification Fee
Once payment is received, you will be enrolled in the Certification process and have access to all of the information needed to help support your journey towards becoming a Certified Birth Healing Practitioner!

Name(Required)

First Last

Email(Required)

State/Territory and Country(Required)

Occupation(Required)

How many years have you been in this occupation?(Required)

License Number(Required)

Are you licensed to do internal work? If so, are you currently practicing internal work?(Required)

Why are you applying for certification?(Required)

What 3 goals do you have personally or professionally that you think Certification will help you achieve?(Required)

What type of support would you like to receive as you work on getting Certified?(Required)

How do you learn best?(Required)

What pain points are you experiencing in your career right now?(Required)

What would you like to improve in the care you are able to provide to your clients?(Required)

Where will you be practicing and in what capacity upon completion of the Certification program (to the best of your knowledge)?(Required)

What questions do you have regarding the Certification program or process?(Required)

Is there anything else you would like to share?(Required)