Intake Form - Patterns To Presence

Welcome to the Patterns to Presence program! Before continuing, please complete our waiver form.
1. Click here to download the waiver form.
2. Digitally sign it using Smallpdf (click here to go now).
3. Upload the signed PDF below.
Upload waiver form*
Accepted file types: pdf, Max. file size: 5 MB.
What is your name?*
First Last
What is your email address?*
What is your phone number?*
What timezone/city do you live in?*
How did you hear about this program?*
- Through Sabrina
- Through Zamir
- Through Farah
- Through someone else who went through it

We take commitment to personal growth very seriously.

We expect all participants to show up consistently whether it's completing journaling assignments, CI sessions, or workshops.

When you book your CI appointment, you are holding a space on our calendar that is no longer available to others. If you need to cancel your appointment, we respectfully request at least 48 hours notice. Any cancellation made less than 48 hours in advance will result in a cancellation fee of $90.

Missing a day of journaling without advance notice is equivalent to missing a CI therapy session. If you miss a day of journaling without 24 hours' advance notice, you will be responsible for a penalty fee of $85.

If three consecutive days of journaling are missed without any notice, your journey will automatically pause. In order to resume the journey, there will be a penalty fee of $275.
Your Acknowledgement of Penalty & Cancellation Fees*
I agree to the above stated cancellation fees.
Is there anything else you would like to share with us before we start the program?

Program Intake Form