Nova Vida is for people seeking deep healing and transformation in their life. If you are interested in becoming a guest with us, please thoughtfully fill out the application below. We look forward to connecting with you and exploring the possibilities of your journey with Nova Vida.

Name

First Name

Last Name

Phone

(###)

###

####

Birthday

YYYY

Briefly describe your situation and the support you’re looking for:

Please list all drugs (including street drugs, alcohol and all prescription medications, psychoactive and non-psychoactive) that you have consumed within the last three months, and frequency of consumption:

When would you like to begin your stay at Nova Vida?

Have you ever been diagnosed with a mental health disorder? Please specify what and when?

Do you have any physical health issues -- illness, extreme allergy, physical limitation, pain or injury? Please specify.

How did you hear about us?

What motivates you to seek a New Life?

Additional Info / Comments

House of Healing & Integration