Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *What is the biggest reason, challenge or goal that brought you to this program? *Please describe your current state of health in your physical body: *Have you been diagnosed with any illnesses, diseases or disorders? *What would you like to be different, better or more in your physical world (health, fitness, nu-trition, and/or things you have in your life)? *Are you on any medication (please list dosage & info.)? *Are you over weight? If so, by how much? *Do you have high blood pressure or high cholesterol?How many hours per night do you sleep?History of mental illness or depression? *Have you ever received any advice or warnings regarding physical exercise by a doctor? If so what? *What would you like to be different, better or more in the ‘mental’ area of your life (thoughts, patterns, habits and self perceptions)?What would you like to be different, better or more in your spiritual life?WebsiteSubmit