Name
*
First Name
Last Name
Email
*
Phone
(###)
###
####
What wellness topics are you most interested in exploring?
*
What is your birthday
MM
DD
YYYY
Do you have any dietary restrictions?
*
How did you hear of us?
A friend or family member
Facebook
Instagram
Other
Yoga experience
Beginner
Intermediate
Advanced
What are your personal goals and aspirations for attending this retreat, and how do you envision the ideal experience supporting your journey toward those objectives. Describe:
Needs - What would help you achieve your goals? (e.g., coping skills classes, encouragement to opt out of scheduled activities, encouragement to participate in movement activities i.e. yoga/walking, quiet time alone, etc.) Describe:
Preferences – What preferences do you have? (group based activities, quiet hours in the morning vs evening, specific coffees or tea, etc.) Describe:
Please share any additional information about you that would be helpful in curating a retreat (i.e. recent loss of a loved one, history of trauma, desire to work on anxiety or depression, parenting discussions, etc)
Thank you so much for choosing to share information to help us build a retreat specific to your wellness journey. Once the retreat is full or 30 days before the retreat, whichever happens first you will receive your schedule, driving instructions, check in details, etc.
If you have any questions in the meantime, please feel free to reach out!
Sincerely,
mesquite wellness
