Questionnaire

Name

Dates of Retreat Attending

Type of Accommodation preferred

Home address

Phone Number

Email address

Age

Gender (M or F)

Height / Weight

Do you see yourself as under weight, over weight or neither?

Do you eat as a vegetarian, vegan, raw foodist or other? If so, which & how long?

How would you describe the way you eat?

Do you eat or drink on a regular basis...

Meat

Dairy (milk, eggs, cheese)

Vegetables

Fruits

Sweets (chocolate, candy, desserts, etc)

Fried foods

Raw foods

Soft drinks (soda, canned/bottled juices, etc)

Caffenated drinks

Coffee

Alcohol

Filtered/purified water

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 health is... (fill in the blank with as many descriptions as possible)

Please answer with as many descriptive words as possible.

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)

My weight 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?

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Questionnaire

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