Freedom Intake Form
Sign in to Google to save your progress. Learn more
Name *
Age *
Occupation *
What is your level of stress? (1 minimal stress, 10 extreme stress) *
Do you have any injuries or health conditions (both past and/or present)? *
Describe your weekly physical activity. *
Describe your diet. *
Describe your spiritual or religious or self-care practice. *
Are you aware of any limiting beliefs or recurring self-deprecating thoughts? *
What habits would you like to break? *
What is your relationship with time? *
Why do you want to participate in this program? What do you hope to release/gain? *
What are you willing to let go of so you can have what you've always wanted? *
How committed are you to transforming your life for the better? 1-10 *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy