Your Name (Mr./Mrs./Ms)
Email Address
Married/Single/In A Relationship
Nationality
Age
Date Of Birth (To define the ideal journey for you)
How is Your Physical Well-being?
Q.: Do you suffer from any of the following issues: Chronic pain, low energy, poor sleep, digestion issues, low immune system, other?
Q.: Are you taking any medications, herbs, or supplements? Please provide a list if you do.
Q.: History of recent hospitalization or surgery in the last 12 months.
Q.: Do you have any dietary restrictions and/or allergies/ food intolerances?
Q.: What form of physical activity do you perform regularly?
Q.: Do you smoke? Or do you drink regularly?
How is Your Mental Well-being?
Q.: What are the things or activities you enjoy participating in?
Q.: Do you have concentration and memory problems, brain fog?
Q.: How would you describe your daily stress level? Low, moderate, high?
Q.: Have you suffered from depression or anxiety?
Q.: What is your most common response to stressful events or situations?
Q.: What form of mindfulness activities are you familiar with?
How is Your Spiritual Well-being?
Q.: What are the main things that you are grateful for?
Q.: Where do you find inspiration and connection the most? In nature, with the family, your animals, in arts, the divine?
Q.: What form of spiritual activity do you practice? Any form of prayer, yoga, meditation, charity work, or other?
Q.: What could be holding you back from reaching your full potential of happiness? Is it yourself, your job, your partner, your children, money issues?
Q.: What have you achieved recently that brings a sense of meaning and enjoyment in your life today? A recent marriage, a child, a promotion, new business, or a hobby?
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