Lanzarote Retreat Welcome Intake

Please fill out this form so I can better know you and your needs during out time together.

Name

First Name

Last Name

Phone

(###)

###

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Birth Details

Date*, Year*, Time*, Place*

What are your current wellness rituals?

What does your current meditation practice look like if any?

What is your workout routine like?

How Many days a week do you move your body? What time of day? What do you prefer as your workout method. etc.

How is your sleep?

Do you drink coffee?

Do you drink alcohol

Do you smoke cigarettes?

Do you take medication?

What is your state of mind most of the time?

Do you feel stressed? Joyful? Peaceful?

What is your dream or desire for yourself and life?

Share in as much detail as you’d like.

What are your fears and struggles? What area would you like to improve?

Why did you choose this retreat?

What are you hoping to gain from this experience?

Anything else you'd like to share with me?