Embodied Dharma Application

Private Immersion Application

This is a brief application to explore if a private immersion with Ajaya is an aligned match for you at this time. Please be as honest and detailed as possible. Allow these questions to serve you in becoming more intimate with yourself, as well as allowing me a better understanding of where you are. It is important that I understand any medical, or life style habits that may be influencing your experience. This form is completely confidential. I will reach out to you to set up a time to explore moving forward and crafting an immersion together. Thank you for your interest and for taking the time to feel into what you most want for yourself and your life's greatest expression.

First Name

Last Name

Website if you have one

Where do you live?

Birthday

What is your profession or primary work?

What is the primary focus and devotion of your life right now?

What areas of your life are you feeling less than thriving and are seeking support?

What do you see as being the biggest obstacles in your way in terms of creating your life on your terms- the one you would most love to live?

Do you have any experience working with plant medicines, MDMA or any other therapies that support going deep into the unconscious?

What are some of the blocks or narratives that come up when you lean towards doing the necessary internal work to create what you want for yourself?

In what areas do you sense you would need the most support in embodying what you most want for yourself and for your fully expressed life?

How is your relationship with trusting yourself? Are you able to stay true to commitments you make with yourself even when feeling confronted?

How is your relationship with boundaries? On a scale of 1-10 ( 1 being, " I don't know what a boundary is!" to 10, "I am a master of owning my space and taking care of my needs").

Do you have experience with Pranayama or other forms of breath work that may activate your Kundalini or create an increase of your life force-- aka a 'flow state'?

Are you on any medications for mental or physical health reasons? If so, may I please know what they are?

Are there any questions you have for me or anything else you would like me to know about you that would support our discovery call together?

Thank you

For taking the time to fill this out. See you soon!

We value your privacy and have a no-spam policy.