Balanced Explorations Intake Form

Luxury Sustainable Travel or Autism Travel Intake Questionnaire

To determine whether we are a good fit to work together, please provide the answers below.
Personal Information:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Questions and Details of your Travel History:
Describe your travel style in a few words. *

0/200
Have you ever worked with a travel advisor before?*

YesNo
How many times a year do you travel in general? *

0/30
Approximately how much do you spend per trip?*

0/20
Do you generally purchase travel insurance?*

YesNoNot yet, but I will in the future because I want to be able to cancel for any reason or not lose 100% of my non-refundable payments.I'll consider it. Tell me more.
Are you ready to plan and place a deposit on your travel now?*

YesNo
Describe the trip you would like me to plan for you in detail. *
What are your dates of travel? *
What is your budget for this trip? *
How many people will be traveling with you? *
Does anyone you will be traveling with have special needs? What type of accommodations will be required?*
Are you ready, willing, and able to pay a Travel Planning Fee based on the complexity of the trip you would like me to plan after our Consultation phone/video call? (Planning work will not begin until this payment has been made.)*

YesNo
How did you find me? Why do you want to work with me? *
If after reviewing your intake form I determine we are a good fit, I will email you to schedule a consultation to determine the scope of work, timeline, and Travel Planning Fee. If you have any additional comments, please type them below.
Do you want to be added to Balanced Explorations email list and receive information on travel, specials, and future services.*

Yes, please add me.No, I'll hold off for now, but you can email me in connection with this request.
Should be Empty:

Luxury Sustainable Travel or Autism Travel Intake Questionnaire