Book your Divine Healing Session with Antonya First Name(Required) Last Name(Required) Birth Certificate Name(Required) Email(Required) Enter Email Confirm Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands What is you timezone?(Required) Date of Birth(Required) Medical InformationList any past surgery, serious illnesses, accidents or injuries with the dates and details.(Required)List any medication or supplements you’re currently taking.(Required)How would you describe your current emotional state? Are you feeling stressed, anxious, unhappy, angry etc.(Required)What are your current stresses? Is there a particular stress, trauma or emotion that feels overwhelming right now?(Required)Relationship with mother - Describe your relationship with your mother whilst growing up & how it is now.(Required)Relationship with father - Describe your relationship with your father whilst growing up & how it is now.(Required)Your environment - Please describe your present home and family environment.(Required)Your occupation - Please describe your main occupation. Are you happy in it?(Required)EQ (Emotional Intelligence) - How well can you feel the full range of human emotions e.g. fear, anger, despair, grief, anguish, terror, guilt, shame, hopelessness, rejection, abandonment, mistrust, unworthiness etc.(Required)Please list in order of priority what you feel you most need help with(Required)Marketing and Terms and ConditionsWould you like to join our mailing list?(Required) Yes, I would like to join CFCA's mailing list only to receive informative and helpful emails about trainings, webinars, free resources, products and special offers that may support you. You will only receive emails once or twice a month. Yes, I would like to join Antonya's mailing list only No thank you, I don't want to join any mailing list at this time Are you aware of my cancellation policy?(Required)With respect to my time and other clients who may have attended in your absence, I ask you to pay half the treatment fee if the cancellation takes place within 24 hours of your appointment. I understand I have to pay 50% of my appointment fee if I cancel with less than 24 hours notice I understand that healing is not a medical treatment. I also appreciate that it is my responsibility to seek medical care for any problem or illness(Required) Yes I understand the above Payment and Booking your Session(Required)After you have submitted this form you will be redirected to Antonya's booking page which is away from The Center for Conscious Ascension's website. There, you can schedule and make payment of £133 for your healing session. Please note that you have not booked your session until payment has been made. Yes I understand I will be redirected to https://antonyabeamish.as.me/divinehealingCFCA where I will be asked to make payment and book a session time. Δ