For the most successful and fulfilling results of the retreat we need some basic information about you. Please, take your time to fill out this form.

Name *
Name
5. Please provide us with details regarding your health condition. If needed, use the space at the end of this part for any additional information you find relevant.
Do you suffer from any chronic symptoms or any other physical conditions? *
Are you now, and/or have you been in recent years, under any regular medical treatment? *
Are you now, and/or have you been in recent years, under psychiatric and/or psychological care? *
Have you ever undergone surgery? *
For women: are you pregnant?
I confirm that the information, which I have provided is true and accurate. *