Application Form
You don’t need more pills — you need a space for realignment. That space is The Inner Reset.
Name
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Name
Surname
WhatsApp Number
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Country code (example : +44 for the UK)
Phone number
Email
*
What is your profession
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Your story
What are the main physical or emotional challenges you’re experiencing right now?(For example: burnout, anxiety, bloating, hormonal imbalances, irregular cycles, fatigue, emotional overwhelm, feeling disconnected from your body…)
When did these challenges begin, and how have they been affecting your daily life, relationships, or self-confidence?
What have you already tried to feel better?(For example: therapy, yoga, Ayurveda, meditation, supplements, diet changes, alternative therapies… What helped? What didn’t?)
What would you most love to change or achieve in your health, energy, or emotional balance in the next few months?(For example: feeling calm and grounded, having stable energy, balancing hormones, improving digestion, feeling at home in your body…)
Your readiness
What feels most difficult or scary about making these changes?
Why do you feel now is the right moment to start this journey?
On a scale from 1 to 10, how ready are you to commit to your healing and to creating supportive daily habits?
Why did you choose that number?
Practical information
Which type of support are you most interested in?
1-on-1 Emotional Reset Session
1-on-1 Full Ayurvedic & Emotional Balance Coaching
Group coaching
Not sure yet — I’d like your guidance
Being aware The Inner Reset coaching is not free. How much are you ready to invest in your health this year ?
€1000–2999
€3000–6999
€7000-10000
How did you know me?
Instagram
LinkedIn
Referral
Other
Please share anything that will help prepare for our meeting
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