Elemental Vitality Application Name * First Name Last Name Email * Location / Time Zone * How did you hear about Elemental Vitality / from whom? Why This Now What’s calling you to this work? (What’s your longing?) * What is your primary goal(s) in working together? (You can name 1–3.) * What would “success” look like for you at the end of this container? * Your Health & Energetic Terrain What are your top 3–5 health or vitality challenges right now? (E.g., fatigue, PMS, hormone imbalances, mood shifts, insomnia, digestive issues, etc.) * For how long have these been present? * What have you already tried (modalities, diets, protocols, therapies)? What helped? What didn’t? * On a scale of 1 to 10: How ready are you to deeply invest (time, trust, energy, discomfort) in the changes you’re seeking? 1 (Not ready at all) 2 3 4 5 6 7 8 9 10 (100% Ready) What concerns or fears do you have about starting this work? * Alignment & Commitment This container is not for quick fixes or external fixes only. Are you willing to do inner, foundational work (nutritional, energetic, lifestyle, mindset) and stay consistent? * Are you available to meet monthly (or on the cadence we agree), do homework / practices between calls, and show up for your body? * Do you have any constraints (time, finances, location, travel, etc.) that might make full participation challenging? * Is there anything else I should know to support you best (medically, psychologically, energetically, etc)? Optional (but deeply illuminating) If you could send a message to your body right now, what would you say? What are you hoping the body will reclaim or remember in you? Thank you!