Retreat Intake Form

Please fill this form in at least 1 week prior to travel. It is important that you provide as much detail as possible to enable Natalie to prepare your experience.

Thank You!

Name

First Name

Last Name

Email

Phone

Country

(###)

###

####

DOB

MM

DD

YYYY

Medical/Dietary Concerns: Please list all issues concerning allergies, significant injuries (current and past), medications you take, illnesses/diseases, dietary restrictions, etc.

Is there anything you would like Natalie to know about your current mental or emotional state?

Information on this form will be kept confidential and is collected to provide support and safety during your retreat.

What do you hope to gain/experience/learn from this retreat?

Are you physically active?

Yes

No

Do you practice yoga?

Yes

No

What styles of yoga do you practice?

How many times a week do you practice?

What kind of practitioner do you consider yourself to be?

Beginner

Intermediate

Advanced

Is there anything else you would like to share before we embark on this journey together?

Waiver

By submitting this form, you are aware that yoga & the other techniques utilised during the retreat involve physical movements and breathwork that may not be suitable for everyone. You are encouraged to seek the advice of a health professional before beginning any new physical activity. Yoga or other modalities used are not a replacement for care, medical attention, examination, diagnosis or treatment by your health professional..