The BODY 5D >> Purify, Cleanse 4 week detox

Email address *

Name (First / Last) *

Phone *

What are you most curious about? *

Clearing emotions, new ways to express, embody authenticity

Learn chakras, energy centers and how to balance

Dynamic breath / movement practices to harmonize my emotions/energy

Learning about detoxing, cleansing the body

Doing the 3 day juice FEAST (fast)

How to cultivate my energy, and feel, lighter more free in my body

All of the above!

Other:

What is the biggest motivating factor for your growth and transformation right now? *

Do you have any injuries or restrictions I should know about? *

Do you currently have a meditation practice? *

I've never meditated, but interested

I've tried, and struggled with it, but I'm open

I meditate a little each day

I am the all knowing buddha

How long have you had a yoga practice? *

I don't have one, and I'm not interested

I don't have one, but I'm looking to build mine

1 - 3 years of practice

4 - 7 years

10 + years

I have a practice, but fell off a bit, I'm looking to build it back up

Other:

How good/healthy are your eating habits? *

I'll eat anything I don't care

I eat a little meat, veggies, and some fish

I eat mostly veggies and occasional fish

I'm vegetarian

I'm vegan

I'm all raw

Other:

Do you feel connected to 'god', 'higher self' or spirit? *

I know that I'm connected, but I don't necessarily feel it

I've experienced moments of connection

I connect daily

I can't turn this shit off, its hard to be in my body

I am god

Other:

How do you think The BODY 5D will support your growth? *

What do you think will serve your highest self and goals right now? *

Intermediate level (4 weeks) - Emotional/Energetic clearing, Nutrition/fasting

Advanced level (3 weeks) - Sacred sexuality, Intimacy/pleasure/partnership

Both Intermediate & Advanced levels (7 weeks)

Not sure

Who do you want to be when this program is complete? *

Would you like to hop on a FREE call with Natalie to discuss further? *

I look forward to reading your responses. I will get back with you to discuss asap. Thank you so much for the time and intention you put into this application. In Gratitude, love Natalie Pierson

A copy of your responses will be emailed to the address you provided.

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