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Temple of the Maiden Application
Next Level Goddess
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Email
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Your email
Name
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Your answer
What do you hope to get from this program?
Your answer
Why "Temple of the Maiden?" What drew you to this program?
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What are you hoping to offer this program?
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If you could pick 3 main goals/intentions for this program, what would they be?
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Will family and/or friends be supportive of your desire to make lifestyle changes?
Yes
No
Maybe
Other:
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Do you currently take part in any self care practices/rituals?
Your answer
What does a day of meals look like for you? (These are questions for the private nutritional coaching call if you choose to utilize it)
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What percentage of your food is home-cooked? (These are questions for the private nutritional coaching call if you choose to utilize it)
0
1
2
3
4
5
6
7
8
9
10
100%
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Do you crave sugar, coffee, cigarettes, or have any major addictions? (These are questions for the private nutritional coaching call if you choose to utilize it)
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The most important thing I would like to change about my diet to improve my health is... (These are questions for the private nutritional coaching call if you choose to utilize it)
Your answer
Have you used herbal supplementation before? If so, what has worked for you and what has not? (These are questions for the private nutritional coaching call if you choose to utilize it)
Your answer
What are you most excited for in this program?
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Questions, Comments, Concerns?
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Thank you :)
I look forward to thriving with you!
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