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2023 Private Retreat Request Form
1
Name
*
This field is required.
First Name
Last Name
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2
Email
*
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example@example.com
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3
Select the preferred arrival date for your private retreat.
*
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This just gives me a general idea of when you'd like to come; it can be changed later.
-
Date
Month
Day
Year
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4
Select the preferred departure date for your private retreat.
*
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This just gives me a general idea of when you'd like to leave; it can be changed later.
-
Date
Year
Month
Day
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5
What would you like to work on?
*
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If you're not sure, just give a few things that have attracted you to work with me
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6
What is your top goal of our working together?
*
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This just gives me a general idea of what we will work on; it can be changed later.
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7
What are some areas/ways that you're currently accessing for your self work?
*
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This just gives me a general idea of when you'd like to return: it can be changed later.
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8
Are your dates flexible?
*
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Yes
No
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9
What is your departure city?
Where will you be flying from?
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10
How many travelers?
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11
What is your total budget for all travelers?
*
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This just gives me a general starting point and can always be changed later.
$2500 to $3500
$3500-5000
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12
What best describes your session preferences?
*
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Mentorship
Talk centered
Touch centered
Meditation centered
Combination
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13
What kind of vibe are you looking for?
*
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Check all that apply!
Erotic
Rest and relaxation
Grounding and centering
Shamanic spiritual healing
Plant Medicine
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14
What additional activities are you interested in?
*
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Check all that apply!
Beach and Water
Yoga and Tai Chi
Meditation and Journaling
Hiking and Nature
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15
What else would you like me to know?
*
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What else would you like me to know about your traveler's budget and/or travel preferences?
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