Application for High Vibe Life Coaching with Siddheshwari Devi

Full Name

Email Address

Moblie Number

Facebook Username

Age

Occupation

Current Weight

Ideal Weight

Which coaching option are you applying for? Which coaching option are you applying for? Group Coaching Program 1-on-1 Coaching

What inspired you to get coaching now?

What are your specific health and body composition goals?

What key factors do you believe will help you most in reaching your goals?

Which BEST describes your current nutrition plan? Which BEST describes your current nutrition plan? I am new to plant-based and still eat some meat/fish/eggs/dairy AND/OR I am transitioning from keto/low-carb/Atkins. I eat 100% plant-based (zero animal products), but still include processed foods* on most days. I eat 100% plant-based (zero animal products), mostly whole foods (minimal processed foods*) and have eliminated one or more of the following: sugar, oil, salt, gluten, food chemicals/additives. I eat 100% plant-based (zero animal products), mostly whole foods and have cut out one or more of the following: sugar, oil, salt, gluten, food chemicals/additves. PLUS I also include a good amount of fresh foods (fruit, salads, smoothies, juice, etc). I eat 100% plant-based, mostly whole foods and have been experimenting with raw vegan nutrition.

* Note: Processed foods may include: packaged meat and dairy substitutes, boxed/canned/frozen meals, bottled condiments and any refined ingredients (sugar, oil, flour, etc).

What are you currently doing to balance your weight? What results are you getting?

Please list any current health conditions you are experiencing and related treatments (pharmaceuticals, supplements, therapies, etc.)

Which is your preferred healthcare provider? (You may see a combination of practitioners, but which category is your main go-to for health advice?) Which is your preferred healthcare provider? (You may see a combination of practitioners, but which category is your main go-to for health advice?) Naturopathic Doctor, Chiropractor, Ayurvedic Doctor, TCM Doctor, etc. MD, Integrative Doctor or Nurse Practitioner

Have you seen any plant-based documentaries (e.g. What the Health, Game Changers, Food Matters, etc.)? Have you seen any plant-based documentaries (e.g. What the Health, Game Changers, Food Matters, etc.)? Yes No

Do you have a supportive community to help you reach your health and weight balance goals? Do you have a supportive community to help you reach your health and weight balance goals? Yes No

On a scale of 1-10, how motivated are you to make positive lifestyle changes? (1 = minimally, 10 = highly motivated)

What is your biggest motivation to make this change now?

Achieving positive personal transformation and reaching your ideal weight requires an investment of time, money and energy to make it happen. Please comment on your ability and willingness to invest in your Self in order to achieve your goals.

We recommend buying only organic produce because it is the BEST on every level. Also, our program includes recommendations for herbal supplements that are highly beneficial for optimal results (approx. $100 in addition to coaching fee). Are you able to include these success elements in your budget? We recommend buying only organic produce because it is the BEST on every level. Also, our program includes recommendations for herbal supplements that are highly beneficial for optimal results (approx. $100 in addition to coaching fee). Are you able to include these success elements in your budget? Yes No Possibly

Is there anything else you would like to share that may be helpful for us to know?