Pre-retreat questionnaire

Pre-Retreat
Questionnaire

Please complete the form before the start of the retreat

Full Name

Phone

Emergency Number

Email Address

Medical conditions

List of regular medications

It is good to know a bit more about you. Is there anything you would like to share?

Do you like to get up early or sleep in?

What is your eating habits? What do you like to have for breakfast, lunch & dinner?

Please list previous retreat or holistic therapy experiences:

Are you going through and physical or emotional challenge?

Food dislikes or preferences:

What are your expectations for the retreat?

I consent to having my picture taken.

I consent to photografs of me being used for promotional purposes by Maria Bela Andrade.

I confirm that I take responsibility for my health and safety during the retreat activities. In the event of an accident, I agree not to hold the organiser liable for any injury, death or personal property damage or loss.

Thanks for submitting!

Pre-Retreat
Questionnaire