Name
Dates of Retreat Attending
Type of Accommodation preferred
Home address
Phone Number
Email address
Age
Gender
Height / Weight
Do you see yourself as under weight or over weight?
Are you a vegetarian, vegan, raw foodist, fruitarian, liquidarian or breatharian? If so, which & how long?
How would you describe the way you eat?
What do you eat/drink most often?
What foods do you crave?
How do you choose your food (taste, health, calories, convenience, etc)?
Do you cook your own foods? How often?
Do you own a juicer? How often do you use it?
Do you exercise? What type and how often?
Describe how you you sleep?
Do you take any supplements? If so, what?
Do you take any medications? If so, for what?
My body is... (fill in the blank with as many descriptions as possible)
Eating is... (fill in the blank with as many descriptions as possible)
Fasting is... (fill in the blank with as many descriptions as possible)
My life is... (fill in the blank with as many descriptions as possible)
Have you ever done a fast/cleanse? What type/how long?
If yes, what was your reason for doing it?
What was your experience like?
Do you currently do any spiritual/contemplative practices (yoga, meditation, tai chi, etc) Please describe.
Have you ever worked with medicine plants? If so, describe your experience.
How would you describe your spiritual beliefs?
Do you have any physical, mental or emotional challenges that you would like to address during the retreat? Please explain.
Do you tend to enjoy being alone or with others?
What are the top values in your life right now? (what's most important to you)
What is your reason for wanting to attending the retreat?
What outcomes would you like to see as a result of attending the retreat?
Do you have any fears or concerns about the retreat? if so, please describe them.
How did you find The Fasting Path?
Anything else that you would like me to know or ask?
