Holistic Retreat Application Request
We will mail the necessary forms and application to you due to patient privacy laws. Please pay the registration fee online or mail to Swan Creek Farm, 1736 Swan Creek Rd. Hamptonville, NC 27020 to proceed. Please do not include any medical info on this form.
Phone Number That We Are Allowed To Contact You At:
Your twitter account (@canceraftercare):
Your facebook address:
URL to your blog:
I understand that herbal therapy is an integral part of the therapy provided. I will use the herbal therapy prescribed to me by Dr. Browne. I am not taking medications that will interfere with herbal therapy, or my course will be completed by the start of the retreat.
Please list your 1st, 2nd, and 3rd preferences for retreat dates which are listed here:
Do Not Fill This Out