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FlourishWell Thailand Retreat Waitlist
Personal Information
Full Name
*
First Name
Last Name
E-mail
*
example@example.com
How did you hear about us?
Please Select one
Google or another internet search
Word of Mouth
Social media
Other (Please specify...)
Other
Age Group
21-34
35-44
45+
Do you have ADHD?
Yes
No
Maybe
Retreat Goals & Expectations
What interests you the most about our Flourishwell Retreat? (choose as many as apply)
Holistic management of ADHD symptoms
Having a community of women like myself
Destination specific (Thailand)
Daily mindfulness practices and yoga sessions
Personalized wellness plans tailored to your needs
Relaxation and Recharging
Other
Other
What are your top goals for attending this retreat? (choose as many as apply)
To manage ADHD better
To reduce stress
To gain creative inspiration
To improve overall wellness
To connect with other women with similar experiences
To work on personal growth
Other
Other
Have you ever attended a wellness or creative retreat before?
Yes
No
Are you currently practicing any form of wellness or mindfulness activities (e.g., yoga, meditation, journaling)?
Yes (If yes, please specify.)
No
Please specify
Retreat Experience Preferences
What activities are you most excited about during the retreat? (choose as many as apply)
Yoga
Meditation
1-1 Coaching
Group Coaching/Sessions
Sound Healing/ Sound Therapy
Painting
Writing
Photography
Hiking
Excursions
Which tier would you prefer to book? (Check website for more details on tiers)
Tier 1
Tier 2
I don't know yet
Commitment & Logistics
Are you ready to commit to attending the retreat in Thailand?
Yes, I'm ready to book as soon as the details are available.
I need more information before committing.
Not sure yet
Do you have any questions or concerns regarding the retreat that you’d like addressed before signing up?
Payment & Availability
Are you aware that a deposit on 20% is required to secure your spot?
Yes
No
Would you like to receive early access to booking or special promotions when the retreat becomes available?
Yes please!
No thank you
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