Because therapy is not a luxury...

Register for therapy at a reduced rate.

Please feel free to fill out this form if you feel you are in dire need of body-oriented therapy, would like to invest in your health, and would like to start a program, but don't currently have the financial means to do so.

This form is available to help us determine whether you are eligible and how we can best support you.

Please note that all information you provide will remain completely confidential and will only be used to contact you regarding your application.

You can answer as briefly or as extensively as you like.

Your story is welcome – exactly as it is now.

Name

Age

Date of birth

Month

Day

Year

Time of birth

Place of residence

GSM

E-mail

Reason for your request (short open question, no mandatory long explanation)

Are you currently receiving psychological, medical or other support?

Can you briefly explain why it is financially difficult for you to finance this process?

On which days/times would you generally be available for sessions?

I agree to the confidential processing of my data for this application.