ISCHISCHAs Prep for Colonoscopy
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Application
      
Application For Colon Hydrotherapy Certification Program
First Name *
Last Name *
Address *
City *
State/Province *
Postal Code *
Country *
Phone 1 *
Phone 2
Mobile/Cellular
Email *
Social Security Number ###-##-####
Date Of Birth * mm/dd/yyyy
Current Profession
How Long?
Previous Profession
Education Degrees

      

In order to have some idea of your learning styles, please answer the following questions to the best of your ability so we may serve you best.*
  1. Do you absorb information better as a reader or a listener?
    ReaderListener
  2. Does writing notes immediately following a meeting make it easier to remember ideas?
    YesNo
  3. Are you a loner or do you work better as part of a team, with just a few people or an adviser?
    LonerTeam
  4. Are you best in a structured, predictable environment?
    YesNo
  5. Do you need a lot of open space to be creative?
    YesNo
  6. Do you work best under stressful conditions or with few stresses?
    StressfulLess Stressful
  7. Do you work best with several different tasks to juggle or one at a time?
    SeveralOne
  8. Have you ever had any colon hydro treatments?
    YesNo
  9. Was it a closed system with disposable tubing?
    YesNo
  10. Do you have any background in anatomy & physiology?
    YesNo
  11. Are you free to take a week off and travel to Florida for the course?
    YesNo
  12. Do you have a medical condition that requires you to take medications daily?
    YesNo
  13. What is the best time of day to reach you?
    AMPM
  14. Please list your four top strengths:
  15. Please list four areas where you want to improve:
  16. Tell us in just a few sentences why you are interested in our course:
  17. Course Date Requested

  18. Are you in the care of a medical professional? If yes, explain.

  19. Are you currently taking any prescription drugs? If yes, explain.

  20. Have you ever been charged with a misdemeanor or felony? If yes, explain.
  21. What health related books have you read?
  22. Describe your relationship with food?
  23. What is your personal mission?


MEDICAL RELEASE FORM: The medical release form must be downloaded and signed by your physician and then mailed or faxed to:
 Cathy Shea School
13878 Oleander Avenue
Juno Beach, FL 33408 USA
Telephone: 561.775.9912
Fax: 561.625.3775



CANCELLATION POLICY: If applicant cancels after paying any money to ISCHT, Inc., they have the right to transfer to another course date within 12 months of application. ISCHT, Inc. reserves the right to retain all tuition payments. WE MUST HAVE A 45 DAY NOTICE FOR THE APPLICANT TO TRANSFER TO ANOTHER COURSE DATE. ANY TRANSFER OF LESS THAN 45 DAYS IS SUBJECT TO A $500.00 FEE.


TERMS OF SERVICE

By submitting this form I understand and agree to the following:
  • I have read and fully understand the Cancellation Policy.
  • ISCHT, Inc. has my permission to perform a background check on me.
  • If I am taking any prescriptions medications, I will have my physician sign the medical release form that I downloaded from above.
  • The entrance to and dismissal from this program may be based on subjective criteria.
  • I have read and filled out all required fields of this form honestly.

We accept We accept all major credit cards.

Additional Information:

Colon Health Care - Natural Health Web

Detoxification - Natural Health Web

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