GENERAL - Health Application (Copy)

Welcome Lifelong Wellness Seeker,

Take Health Into Your Own Hands is for those who value vibrant longevity and understand that true health is a daily practice. Rooted in the ancient science of Ayurveda, this program empowers you to reclaim radiant wellbeing from the inside out—naturally, sustainably, and holistically.

If you’re navigating life’s transitions and feel called to optimize your energy, balance your body and mind, and live with greater clarity and purpose—this journey is for you.

Please take a few moments to answer the questions below with honesty and care. Your responses will help us ensure this program aligns with your vision for a long, vibrant, and deeply fulfilling life.

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?