1:1 Custom Retreat Experience
Registration
A retreat experience curated specifically for you.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
How did you learn about this Wellness Vacation?
Word of Mouth
Instagram
Facebook
Queen By Nature Wellness
1:1 Wellness Experience Location:
*
Treasure Beach, Jamaica
Tulum,Mx
Playa Del Carmen,Mx
Bacalar,Mx
Los Angeles,CA
Palm Springs,CA
Desired Month of Travel:
*
July 2022
August 2022
September 2022
October 2022
December 2022
What's inspiring you to take a Wellness Vacay?
What is your level of comfort when it comes to getting into the water? (pool/ocean/lagoon/river/cenote)
Dietary Needs
*
No Restrictions
Gluten-Free
Plant Based / Vegan
Do you have any health limitations or physical injuries? Please indicate if you have any major health issues (ex high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, mental health concerns, etc.)
*
Are you bothered by scents (essential oils, incense, perfumes etc.)? If yes, please let us know the details.
*
I am ready to make a deposit to secure my spot with a $500 - $1000.
Yes
Not yet, but I will be within the next 30 days
I prefer to pay in full
Social Media
(Optional: LinkedIn/ Instagram / Facebook/Website )
Do you have any Questions or would you like to elaborate on the retreat experience you would like curated?
(optional)
Appointment
*
Submit
Should be Empty: