Ayurvedic Coaching Application

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Please fill out this brief questionnaire so I can get to know you better and understand how to we can best work together! I look forward to hearing from you.

Email *

Name (First and Last) *

Pronouns (he/she/they/etc) *

Phone number *

Share a little about yourself! Where you are in the world, what you do for a living, what you are passionate about, what you are working towards... or anything you feel inspired to share! *

Are you currently experiencing any health challenges that you would like support around? If so, please briefly explain below. *

Have you tried remedying any of the challenges you mentioned on your own? What have you tried? What has worked and what hasn't? *

If you could envision the most ideal and balanced version for your health and life, what would it look like? *

How do you hope to see Ayurveda-Based Holistic Health Coaching support you in reaching your goals? What do you hope to learn, gain, experience or improve? *

What is your level of experience with Ayurveda? *

Little to none, I have no idea where to start

I understand the basics and need help implementing them

I have been practicing for some time and would like support in growth from here

Something else describes my experience

Would you be interested in an ongoing program specifically designed to support you in reaching your goals? Example: meeting 2x per month so you have ongoing support *

Yes

I'm not sure, I would like to learn more

Are you comfortable being on Zoom video for our sessions? (If outside of Indianapolis or would prefer virtual) *

Yes

I would like to meet in person in Indianapolis

I understand that Holistic Health Coaching is not a substitute for medical care. It consists of education, guidance and accountability for optimizing your habits and making healthier choices in life. I agree to reach out for further support from licensed medical professionals if needed. *

Yes

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