Name *

First Name

Last Name

This program meets monthly for Ayurvedic consultations and includes self-care practices, community support, and seasonal rituals. Are you able to commit to attending the full 3-month program?

Yes

No

Unsure

What kind of support feels most nurturing for you right now? (check all that apply)

Routine and Structure

Nourishment (food/herbs)

Rest & Energy Restoration

Emotional Support

Community & Connection

Spiritual/Ritual Guidance

The price of this program is $399 and there is an option for in person body work sessions. Are you willing to make this investment?

Yes

No

Unsure

Optional Add-On Selection

I may wish to include bodywork during the program ($133 per session, scheduled separately).

I prefer to participate in consultations only.

I understand this program is a holistic wellness offering and not a substitute for medical care.

Yes

No