Application for Take Health Into Your Own Hands Program for Those With Chronic Health Issues

Welcome Healing Seeker,

Take Health Into Your Own Hands is for those who are tired of short-term fixes and ready to explore a lasting, root-cause approach to healing. Grounded in the time-tested wisdom of Ayurveda, this program offers a holistic path to restore balance, build resilience, and support your body’s natural capacity to heal.

If you’ve been living with ongoing health challenges—physical, emotional, or both—and feel called to take an empowered role in your wellbeing, this journey is for you.

Please take a few moments to answer the questions below with honesty and care. Your responses will help us determine if this program is the right fit to support your healing, your growth, and your return to vitality.

Name

First Name

Last Name

WhatsApp Phone

Country

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1. What is your biggest challenge you are currently facing and finding difficult to overcome? (Share freely — emotional, physical, spiritual, or relational challenges are all welcome here.)

2. If anything were possible and there were no barriers, what would your life look and feel like 12 months from now? (Describe your vision or heartfelt desire.)

3. If you had a genie granting you one wish from participating in this program, what would you wish for?

How did you hear about this program?

What are your general availability windows (days and times in your time zone) to attend live sessions? (Please list all times that could work for you so we can do our best to find a group time that aligns, should you be accepted into the program.)

Anything else you'd like to share?