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Health Questionnaire

Please fill in and submit your health questionnaire before completing your checkout at the bottom of the page. Once you have submitted your form simply press on checkout to continue your purchase.

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All information is confidential and used solely to support your wellbeing during the retreat.

Medical Information

Do you have any current medical conditions?

Please specify:

Are you currently taking any medication?

Medication and purpose:

Do you have any allergies? (food, medication, environmental)

Please list:

Do you have any mobility limitations, injuries, or physical restrictions?

Please describe:

diagnosed list: Have

Have you had surgery in the last 12 months?

Details:

Mental & Emotional Wellbeing

Do you have any diagnosed mental health conditions that we should be aware of?

Details:

Have you experienced any recent major life events (loss, trauma, significant stress)?

If comfortable, you may share:

Are there any triggers or situations we should be aware of to better support you?

Details:

Additional Information

What are your intentions or hopes for attending this retreat?

Anything else you would like us to know?

Consent & Agreement

By submitting this form, you confirm that all information provided is accurate to the best of your knowledge, and you agree to participate in the retreat with the understanding that activities are supportive, non-clinical, and voluntary.

Please fill in and submit your health questionnaire before completing your checkout. Once you have submitted your form simply press on checkout to continue your purchase.

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