Denver Zen Den Intake Form

1

Your name?* This field is required.

First Name

Last Name

2

Are there specific areas of your life you wish to focus on?Select one or multiple

Physical – health, fitness, energy, body

Mental – clarity, focus, mindset, learning

Emotional – resilience, relationships, inner peace

Spiritual – purpose, meaning, connection beyond self

Professional – career, growth, finances, impact

Other

3

What are your primary goals/interests for visiting the Denver Zen Den?(optional)

5

Lifestyle Information

Knowing your habits, stress levels, and daily activities allows us to create a personalized wellness plan that effectively addresses your specific challenges and enhances your overall well-being.

7

What are your sleep patterns like?Select one or multiple

I usually have trouble falling asleep and often lie awake for hours thinking about things

My sleep is often disrupted due to work stress or personal worries

I experience frequent vivid dreams or nightmares that disturb my sleep

I sleep deeply but don't always feel rested when I wake up in the morning

I tend to sleep well most nights and feel refreshed in the morning

Other

8

Any life transitions/changes you are in right now? What's alive in your world?(optional)

9

Wellness and Health History

We want to make sure we're working with the most appropriate techniques & technologies, avoiding any that might be contraindicated based on their medical background, and enhancing their overall wellness experience.

10

Have you been to the Denver Zen Den before?

YESNO

11

Have you had any issues with strobe or flickering lights in the past?

Yes

No

12

Please share more about your light sensitivity. How can we best support you?

13

Are there any specific health conditions or concerns we should be aware of?(please make sure to always notify if things change)

14

Are there any new health conditions or concerns we should be aware of?(please make sure to always notify if things change)

15

Do you have any worries or fears about the experience that you would like to share with us?(optional)

16

Comfort And Preferences

Learning about your preferences and comfort levels before your experience at the Denver Zen Den is key to providing a truly customized and enjoyable wellness session.

18

What type of meditations do I prefer?We have over 150 sessions, some of which have people speaking to guide you through your meditation, and others are more open and non-linear without words. Let us know what you like.

I enjoy guided meditation with someone's voice giving cues

I like both guided and unguided meditations

I prefer to go inward without any voice assistance

I don't meditate

Other

19

What intensity level of vibration do you find most comfortable?We can turn things up or down during the session, but we like to understand your comfort levels. 1=Light Vibration 6=Heavy Vibration

20

Do you have a preference for scents?

Palo Santo

Sage

None

Other

21

Do you have any questions for the team about what to expect?(optional)

22

Would you like us to capture the magic of your experience with photos and/or videos?This can be an opportunity to anchor in the insights and ah-ha moments that you have in your reflection after your experience. Photos of your experience are also fun to share on social media as this is quite a unique and magical Zen Den.

Yes, I'm good with photos/video being taken

Maybe, let's talk when I'm there

No, thank you

23

Do you have any other preferences or special requests for your sessions?

24

Follow-Up and Support

Understanding your preferred communication methods and desired level of ongoing support enables us to maintain a meaningful connection and effectively assist in your wellness journey.

25

How do you prefer to be contacted for check-ins or accountability over the next 30-days?

I want to be accountable - A weekly check-in via email

I want to be inspired - A check-in after 2 weeks

No additional support is needed

26

Are you interested in resources for ongoing wellness and self-care?Select one or multiple

More education about light, sound, frequency, and vibration and how they help us heal

Discuss getting some 1:1 coaching support

Learn more about the Denver Zen Den's one-month journeys with specific themes

Learn more about one of your upcoming Zen Retreats

Discuss what technology I could use at my home

Other

27

Are you currently taking any medications or undergoing any medical treatments?

28

Are there specific areas of your life you wish to focus on?(physical, mental, emotional)

29

Can you describe your typical daily routine?