Questionnaire

Exact Dates interested: *

Date

Time

Name *

Email *

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 : *

We have two healing center options (please note prices vary from Jungle to 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? *

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