Health Questionnaire

Take your time with this. There is no need to finish it in one sitting, and there are no wrong answers. You might finish it in a weekend. You might do a little each week until it's done.

If any question doesn't apply to you, leave it. If one feels difficult, skip it and come back. And if you have questions while you work through it, write to me.

Basic details

Name

Last name

Phone

Skype

Mailing address

Birthday

Weight

Blood type

Your life

Start wherever feels easiest. You can always come back.

What's going on in your body, right now?

Is there a specific illness or issue you're dealing with? Tell me about it.

How are you sleeping at night?

How do you feel when you wake up each morning? Do you wake up rested, or does it take a cup of coffee to get you going?

Do you have any vivid or recurring dreams?

What's the most significant source of stress in your life, right now?

How do you feel when you step into your home, at the end of the day?

When was the last time you moved your body and broke a sweat?

Your diet

How would you describe your diet, right now? Omnivore, vegetarian, vegan, raw, organic? Different depending on the day?

What's a typical breakfast, lunch, and dinner for you, right now?

What's in your fridge, right now? If you have too many items to list, name five healthy items and five unhealthy items.

What's in your kitchen cupboard, right now? Again, five healthy and five unhealthy is plenty.

What kind of salt do you use?

Where does your water come from? Bottled, spring, plastic bottle, reverse osmosis, carbon filtered, distilled, or straight from the faucet?

Are you taking any vitamins, enzymes or supplements, right now?

Are you taking any prescription medications, right now?

Any food allergies I should know about?

Your purpose & spirit

How do you fill your days? Do you have a job, run a business, raise children, or do volunteer work?

How do you connect with the Universe? Do you have a spiritual practice?

How would you like to transform? Little by little, or all at once in one big immersion? What has worked best in the past?

When was the last time you took a vacation, and where did you go?

What was the happiest part of your day, today?

Why do you want to change your diet?

Do you want clearer thoughts? More energy and creativity? To be able to dance at your nephew's wedding?

What's your driving motivation?

Almost done

Intentions remind us of our responsibilities, and guide us toward the actions that fulfil them. Please set at least one, or as many as you wish.

My intentions

One last thing

Anything else I should know? Any extra detail that would help me understand you.

Beautiful work. You're all done.

Your questionnaire is ready to send.

I can't wait to read your words and connect with you soon.
Love, Peace & Vegetables — Marcela

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