GROUP WELLNESS PROGRAM APPLICATION(1:1 VIP PROGRAM APPLICATION HERE.) Name * First Name Last Name Email * Phone * (###) ### #### How did you hear about BLOOM? * Instagram Facebook Email Google Other Feel free to share personal links here (ex. instagram handle, twitter, website) Why do you desire to be in the BLOOM Wellness Program? Please share some of your journey and why it lead you to apply: * What kind of changes are you hoping to achieve from this program? * On a scale of 1-10, how would you rate how you prioritize your current health or wellbeing? 1 being of highest priority - 10 being lowest priority. Why do you want to work with LeeAna? * This program is a 9 week, 1 hour/week commitment along with daily habit forming rituals and weekly assignments. Is this something you are willing to 100% commit to? * YES NO I'm unsure, let's chat. Is there anything else you'd like LeeAna to know when being considered for the BLOOM Program? Thank you! We will reach out to you shortly.
