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PNES - Support Sanctuary for Women

Founding Member Application

⭐️ Join as an early founding member and help shape the community you’ve always wanted! 

⭐️ All founding members will receive a 50% discount!
⭐️ The first 10 founding members will receive a 75% discount!

Full Name

Email

Phone

Choose your founding membership option

A
B
C
*Limited availability for lifetime VIP membership coupons

What do you most want inside this support community? Rate each item below from 1-10 with 1 being least interested and 10 being most interested.

Peer Support

Education/Resources

Group Discussions

Live Support Calls

Nervous System Healing Tools

Other

What support are you hoping to receive in this group?

What is your biggest challenge living with PNES right now?

I understand membership fees are non-renewable and it is my responsibility to unenroll in the event I am no longer interested in continuing the course.

I understand this is a support group and not a replacement for therapy or medical advice. All suggestions shall be under the advisement of my medical team before implementation.

I agree to email and phone marketing. Text message rates may apply