INNERLIGHT AWAKENING

Ayurveda Consultation Questionnaire

THANK YOU FOR YOUR INTEREST IN TRANSFORMING YOUR LIFE AND YOURSELF THROUGH INNERLIGHT AWAKENING OPPORTUNITIES!

To receive your consultation Call with me, you must fill out the questionnaire completely.
Your thoughtful answers will help me best meet you where you are now and take you where you want to go.
Once you click submit, I will contact you within 2 business days to schedule your consultation call.

Name

First Name

Last Name

Phone

Best phone to contact you on.

Country

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Are you:

Female

Male

Age:

Occupation

Emergency Contact Name and Number

How is your mental health?

How is your physical health?

Please describe any health or medical conditions(s) below:

Please list any medications you are taking:

Do you have any concerns about participating in gentle yoga movements? If so, what are they?

Is there anything else you would like for me to know about you or your health?

Section

From your answers to the following questions, I will have a better picture of your current lifestyle. If you prefer not to answer any of them, please feel free to leave them blank.

Do you currently have a meditation practice? If yes, please list which technique(s) you are practicing.

Describe your worst nutritional habit?

What kind of sleep patterns do you have in general?

What time do you go to bed?

What time do you get up?

What kind of exercise do you participate in and how often?

What lifestyle changes would you like to make?

What activities have heart and meaning for you?

What is the most fulfilling part of your life currently?

What is your greatest challenge right now? (Some examples include: Weight, Lack of Direction or Purpose, Health Issue, Community, Sense of Belonging, Feeling Stuck, A Relationship)

What is currently in your life that you could do without?

Do you have a spiritual practice? If so, please describe the most useful or empowering aspects of your spiritual beliefs?

How do you think that Ayurveda can help you, or what are your goals in coming to see me?

Which of the following areas seem particularly out of balance for you, or what areas would you like to make changes in? Please write each that apply in the box below: Relationships, Career & Finances, Family, Spirituality Health & Wellness, Personal Development, Recreation & Leisure

Once you click submit, I will contact you within 2 business days to schedule your consultation call.

INNERLIGHT AWAKENING

Ayurveda Consultation Questionnaire

YOGA

ONE TO ONE COACHING

MEDITATION

AYURVEDA