Your Name (required)

Surname (required)

Phone (required)

Your Email (required)

What personal issue, challenge or question do you seek an answer to that involves yourself?

How would you like you and your life to be different at the end of these four days?

Why is this important to you?

How important is this to you on a scale of 1-10?
---12345678910

What drew you to the retreat?

If you had a magic wand, what would you wish for when you leave the retreat?

Is this your first retreat? (Yes or No) If yes, tell us of your previous experience

What is important to you for a retreat? (eg super healthy food, personal reflection time, one on
one coaching sessions etc)

How familiar are you with yoga?
---complete beginner10 or less classes2-5 years semi-regular practiceover 5 years of practice

How familiar are you with meditation?
---complete beginnerI have tried a few times but not manyI have tried many variations of meditation and understand the practiceI practice meditation often

Describe your usual waking time and morning routine

How often do you exercise?

How would you describe your current state of health?

Do you have any physical or mental health issues that may be important for us to know?

Do you have any allergies, dietary preferences or food intolerance?

Anything else we should know?