Name *

First Name

Last Name

What is your second biggest motivation for joining this retreat? *

I want to maintain my wellbeing and prevent future disease

I want to cleanse and reset

I want to learn about Ayurveda and holistic health

I want to heal myself from a condition


Other

What is your biggest motivation for joining this retreat? *

I want to heal myself from a condition

I want to cleanse and reset

I want to learn about Ayurveda and holistic health

I want to maintain my wellbeing and prevent future disease

Other

What are your biggest health concerns?

Digestive issues

Aging gracefully

Hormone issues


Skin conditions

Weight management


Mood & energy

Other

Have you practiced yoga before? *

Yes

No

How often do you practice yoga?

Never

Daily

Weekly

Monthly

How do you rate your current level of physical activity?

Very inactive

Somewhat inactive

Average

Somewhat active

Very active

Are you currently taking any medications?

Yes

No