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Application for The SOURCE CODE Yearlong Certification Program with Dr. Sam

Welcome to Dr. Sam & SOURCE CODE

We are so happy you found your way to us, and we can’t wait to support you.

With a background in AI, neuroscience, eastern religion, and psychology, Dr. Sam created a new approach to healing called Source Code, where powerful shifts happen fast. After working with clients for two decades, Dr. Sam discovered there are only 12 negative patterns holding us back in life, which she calls our patterns. When we address these patterns as energy, instead of working with the mind, radical change is possible now.

Please fill out the application below for consideration in the Yearlong SOURCE CODE Certification:

Full Name:

Email

Instagram Handle:

Are you:

A practitioner

Here for self-healing only

How did you learn about Dr. Sam / Source Code?

Tell us a little about yourself. Who are you, and what brings you to this work?

What patterns seem to repeat in your relationships, work, health, money, or sense of self?

Why do you want to join the Certification Program at this time in your life?

What are you hoping will be different for you one year from now?

This is a journey that requires presence, curiosity, and a willingness to look honestly at yourself. What would make you an excellent participant in this program?

What might challenge you?

I would like to enroll in which offer:

Yearlong Certification ($11,000 upfront or $1,111/mo for one year) *You will be directed to to schedule a 1:1 Zoom call with Dr. Sam

The Yearlong Certification is out of my price range, I'd like to take a life changing digital self-led course ($11 - $888) *You will be directed to our digital courses

The Yearlong Certification is out of my price range, I'd like to speak to Ariel about other ways to dive deeper into the magic of Source Code ($333 - $3,000) *You will be directed to schedule a 1:1 Zoom call with Ariel, Source Code Concierge