Application for HeartMath Interventions Certification

HeartMath® Interventions Certification Program Application

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Before submitting your application, please review the HeartMath Interventions Letter of Agreement, the terms of which you will need to agree to as part of the application process.

Letter of Agreement

Yes

I have read the HMI Letter of Agreement and I agree to the terms to be executed upon registration into the HMI program.

HMI Letter of Agreement

Once we receive your application, a HeartMath® representative will contact you to discuss program details and answer any questions. This program includes the Training, The emWave® Pro Plus with assessments, a Manual and four books – Transforming Anger, Anxiety, Depression and Stress.

Name

First Name

M.I.

Last Name

Suffix

Address & Contact Information

Company

Address

City

State

Zip

Country

Email Address

Daytime Phone

Mobile Phone

Please list the professional licenses and/or credentials you currently hold:

Include Type, Number, State & Expiration:

Where do you treat most of your clients ? Include facility and address:

If you are not already a HeartMath client/customer, who were you referred by?

Upon completion of the certification option, please indicate how you prefer your name to appear on your certificate. E.g. Janet Conner, Ph.D.

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Application for HeartMath Interventions Certification

HeartMath® Interventions Certification Program Application