Dr. Dawn's Balanced Living Concierge Services Intake Form

Dr. Dawn's Wellness Travel Planning: Personalized Concierge Services

Personalized Rental Research for Your Dream Wellness Escape
Welcome to Dr. Dawn's Wellness Travel Planning & Concierge Services

As a Physical Therapist and WITT Wellness Specialist, I help you find accommodations that truly support your wellness goals—wherever you go.

Using my evidence-based 5-pillar evaluation framework, I'll curate properties that actively support your well-being, comfort, and health goals by going far beyond pretty photos to ensure your stay enhances rather than disrupts your wellness routine.

My 5 Pillars of Wellness Travel Strategy:
- Physical & Accessibility
- Nature & Environment
- Movement & Recovery Resources
- Nourishment Support
- Curated Wellness Experiences

*Each property is selected to actively support your well-being, comfort, and health goals.

Please note: This service does not include booking or securing the rentals. You’ll receive custom property recommendations only — final booking decisions are your responsibility.
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Purpose of Travel:*
Concierge Package:*
Destination(s): Where will you be traveling? Please enter the specific city, suburb, or general area you'd like to stay in. For best results, list one clearly defined location — such as “within 5 miles of Disneyland,” “downtown Austin,” or “Schaumburg, IL (a Chicago suburb)” — rather than listing multiple cities or neighborhoods.*
CHECK IN DATE*

MonthDayYear
Date
CHECK OUT DATE*

MonthDayYear
Date
Dates of Stay: If your dates are flexible, please specify a range or preferred timeframe.*
Number of Guests: Adults & Children (please include ages, if applicable): Please include approximate ages for children and whether each person needs their own sleeping space.*
Number of Bedrooms Needed:*
Budget Range per Night (USD):*
Budget Range per Month (USD):*
Preferred Type of Accommodation: *
Are you open to a condo or apartment?*
Preferred Location/Neighborhood (if any): close to the city center, beach, nature, business district, etc.*
Activities or Attractions of Interest:*
Experience Preferences: Describe the type of trip or mood you're going for. For example: quiet and nature-focused, romantic and relaxing, or modern and centrally located.*
Key Amenities Needed:*
Health Conditions: Are you recovering from any injuries or managing chronic conditions? Any information you're comfortable sharing helps me find properties that support your wellness needs.
Mobility Concerns: Do you have any mobility concerns or physical limitations?*

Yes, explain below.No
Accessibility Features*

None neededRamps or step-free entryElevator accessGround floor accessGrab bars in bathroomWheelchair accessible shower/tubWide doorwaysOther
Sleep Preferences:*

Require very dark room for sleepSensitive to noise - need quiet environmentPrefer natural light in bedroom during dayNone of the above - I'm flexible with sleep environment
Movement Preferences:*

Gym or fitness center accessWalking trails or safe walking areas nearbyYoga/stretching spaces (indoor or outdoor)Pool or spa accessOutdoor space for movement (patio, garden, balcony)Quiet spaces for meditation/mindfulnessProximity to nature (parks, beaches, mountains)Other
FOR ACTIVE WELLNESS TRAVEL PLANNING ($597) ONLY: What is your PRIMARY activity focus for this trip?

Running/joggingHiking/trail walkingBiking/cyclingSwimming/water sportsSkiing/snowboardingRock climbing/boulderingGolfTennisOther
FOR ACTIVE WELLNESS TRAVEL PLANNING ($597) ONLY: What equipment will you need to rent locally?
FOR ACCESSIBLE WELLNESS TRAVEL PLANNING ($797) ONLY: What specific accessibility features are essential for your trip?

Wheelchair accessible entranceFirst floor master/bedroomsShower chair/bench availableWide doorways (32"+ width)Accessible parking spaceRoll-in showerAccessible Recreation/Sports (specify in other section)Visual and/or Hearing Needs (specify in other section)Other
FOR ACCESSIBLE WELLNESS TRAVEL PLANNING ($797) ONLY: Do you travel with any medical equipment or mobility aids that require special accommodation? What equipment will you need to rent locally?
Services*
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Wellness Travel PlanningFor wellness-minded travelers seeking health-supportive accommodations. This service includes up to 3 accommodation options evaluated through 5 wellness pillars. You'll receive physical comfort and accessibility assessment (ergonomics, safety, mobility), local wellness resources (yoga/movement studios, massage therapy, parks, trails, nature access, etc.), healthy food access (grocery stores, farm-to-table restaurants, dietary options), and personalized recommendations based on your travel preferences. You'll receive property recommendations with wellness analysis, a local wellness ecosystem guide, and personalized recommendations based on your travel goals. This is not a group retreat — just high-quality options customized for your extended stay goals. No bookings are made; this service provides curated research only. *Delivered within 5 business days of completed intake.
$497.00 Quantity



Active Wellness Travel PlanningFor active travelers (runners, hikers, bikers, fitness enthusiasts). This service includes everything in Wellness Travel Planning, plus activity-specific accommodation features (storage, proximity to your preferred activities), advanced recovery resources (recovery studios, stretch centers, infrared saunas, PT/chiropractic clinics, etc.), and equipment rental guidance and local activity recommendations. This is not a group retreat — just high-quality options customized for your extended stay goals. No bookings are made; this service provides curated research only. *Delivered within 5 business days of completed intake.
$597.00 Quantity
Item subtotal:$0.00



Accessible Wellness Travel PlanningFor mobility considerations, accessibility needs, and multigenerational travel. This service includes everything in Wellness Travel Planning, plus detailed accessibility verification and mobility assessment, medical and therapeutic resource proximity, and adaptive equipment rental and accessibility resource mapping. This is not a group retreat — just high-quality options customized for your extended stay goals. No bookings are made; this service provides curated research only. *Delivered within 5 business days of completed intake.
$797.00 Quantity



Total

$0.00
By submitting this form and selecting a package, you agree to receive personalized rental research based on the preferences you provide. This service includes property research and curated recommendations only. It does not include booking, reserving, or managing listings.

Dr. Dawn's Wellness Travel Planning is not responsible for the availability, accuracy, cleanliness, or condition of any third-party property. All bookings are made at your own discretion.

All purchases are final once the research process begins. Please review your information carefully before submitting to ensure your results match your needs.
I agree to the terms and understand this service includes research only and does not guarantee availability or booking.

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Dr. Dawn's Wellness Travel Planning: Personalized Concierge Services