Apply to Living Ayurveda - Year Long Immersion

Living Ayurveda Application

If you're here, it's because you care deeply about your ongoing health and relationship with your body, mind and soul. You're looking for a lasting shift in how you feel every day. You're looking to simplify, slow down, and get back into rhythm.

Take your time filling out this application. it will help me better understand where you are right now, and where you would like to be in the next 3, 6 or 12 months.

First Name

Last Name

Phone

What issues are you struggling with in your body/heart/mind?

Check All That Apply

I need a better routine

I could have better digestion/elimination

I want to improve my yoga/meditation practice

I want to sleep better

I want to learn more about my body type

I need help making better food choices

I don't eat at regular times and often skip meals

What changes would you like to make in how you're living day-to-day?

What is your biggest challenge to making changes or feeling better?

I want to have the following physical/mental/emotional breakthroughs this year....

If our work together were wildly successful, what would your life look like In a year?

Mailing Address

Thanks for submitting!

Fall into Balance, Retreat Day in Port Townsend, Sat, Oct 14th Winter Retreat in Baja, Feb 3 - 10, 2024

Living Ayurveda Application

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