questionnaire

Exact Dates interested

Time

Name

Phone Number

Age

Place & Date of Birth

Occupation

Do you have any health conditions or symptoms you experience daily?

Do you experience anxiety or everyday stress that could be affecting you?

Have you had any traumas in your life? Physical? Mental?

What is your diet like?

The focus / intentions & questions for your sessions

Are you on any medications daily?

Do you consume alcohol on a daily basis?

Do you consume recreational drugs?

What healing techniques spark your interest?

What do you hope to gain from the healing retreat?

Accommodation Options

Jungle Beach

Would you like Our Private Transportation?

Would you like our Meals Prepared by our Private Chef?

What is your ideal budget you’d like to stay at for this retreat?

Questionnaire