Essential Ayurveda for Women Application

Application for Womb Healing Training and Gathering

Please fill the form out in detail and I will email you soont o discuss your application.
Love, Adena

Adena@AdenaRoseAyurveda.com
Full Name*

First NameMiddle NameLast Name
E-mail*
Occupation
Will you be attending in person or online?*

In personOnline
Did someone refer you to this course? (Must fill out for any discount code to apply.)
Tell me about your current healing work for yourself and/or others:*
What would you like to get out of taking this course?*
About how many hours of study in Ayurveda do you have? Do you hold any certificates or professional memberships?
Which stage of life do you consider yourself to be in as woman?*

MaidenMother of any form of 'children' or intention to move into this stage soonQueenCroneOther
If you are menstruating, do you have any of these symptoms associated with your menstrual cycles?*

Painful crampsPMSHeavy bleeding, or bleeding outside of your periodShort cycles (under 27 days)Long cycles (over 35 days)Absent or very irregular cyclesBack painNumbness in the legsPainful breastsOtherClottingNoneChoose not to answer
Check all that apply:*

I am in monthly or daily pain from my periods or digestion.I want to get off of hormonal birth control.I am preparing for pregnancy.I am currently pregnant.I am feeling disconnected from myself.I am struggling with anxiety.I want to learn about some herbs for women's health and fertility.I want to learn more about how to eat for my body type.I am interested in traditional techniques for taking care of my womb.I want to share this with other women professionally.Other
What most called you to apply for this training and gathering? Do you have any specific questions for me?*
Thank you for filling out this application. I will be in touch with you by email soon.
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Application for Womb Healing Training and Gathering