Healing Retreat Guest Interest Form
Help Us Create a Retreat You’ll Love
We’re crafting a healing retreat that blends soulful restoration with nature-based adventure. Your input helps us shape the perfect experience for you.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
Number of Guests
*
Estimate Arrival Date
*
-
Month
-
Day
Year
Date
Estimate Departure Date
*
-
Month
-
Day
Year
Airport Pickup?
*
Yes Please! - Pick me up on arrival
No Thanks - I'll make my own way there
Special Requests
1. What type of setting speaks to you most right now?
By the sea – I crave ocean energy
In the forest – I need grounding and quiet
Game reserve
I’m open to either
I prefer a cozy retreat lodge over outdoor settings
Other
If other, please specify...
2. What kind of accommodation would you prefer during the retreat?
Private room with ensuite
Private room with shared bathroom
Shared room with one other guest
Glamping tent or eco-cabin
Luxury
Rustic
Something in between
Would you be attending solo or with a friend/partner you'd like to share a room with
Other
If other, please specify...
3. Which best describes what you need most?
Deep rest & relaxation
Emotional healing & inner work
Play, fun, and adventure!
Time in nature with gentle movement
A balance of both adventure and healing
Other
If other, please specify...
4. Which experiences are you most drawn to? (Select as many as you like)
Forest hikes, Forest Bathing and grounding practices
Beach Walks
Quantum Energy healing / Reiki
Massage
Spa offerings
Meditation
Sound healing
Journaling + self-reflection activities
Trauma Release Exercises
Breathwork or somatic release
Cold water dips, river or ocean swims
Art therapy or creative sessions
Solo time / guided silence
Yoga
Cycling
Canoeing
Conscious movement/ dance
Animal encounters
Cooking classes
Horse Riding
Game viewing and walks
Reiki Courses
Massage Courses
Other
If other, please specify...
5. How would you describe your physical comfort with adventure activities?
I’m super active – bring on the challenge!
I enjoy moderate activity and movement
I prefer gentle activities and slower pace
I’m recovering from burnout or illness – I’ll need lots of rest
6. Are you more drawn to group experiences or solo time?
I love group connection and shared healing
I want a balance of group and solo
I prefer solo or quiet time to reflect
7. What are you currently moving through or healing from (if you feel comfortable sharing)?
(Optional – to help us support your journey better. All information is kept confidential)
8. Do you have any dietary preferences?
Vegetarian
Vegan
Meat / Omnivore
Gluten-free
Dairy-free
No preferences – I eat everything
Alcohol-free
Other
9. Do you have a budget in mind?
10. Anything else you’d love to see included?
Submit
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