Retreat Intake
Return to Essence

We’re so happy to have you joining us.

To prepare your stay with care and attention, we invite you to complete this short intake form.

Your answers will help us create a calm, supportive experience, tailored to both you and the group.

Take your time, there are no right or wrong answers.

With love,
Lamphai & Candy

Retreat Intake

First name

Last name

Phone

Address/Where are you currently based?

Emergency contact name

Emergency contact phone

Do you have any medical conditions, injuries, or physical limitations we should be aware of?

Are you currently taking any medication?

Yes

Do you have any allergies (food or other)?

Do you carry essential medication (e.g. EpiPen)?

Yes

Do you have any dietary preferences?

Please share any allergies or intolerances:

What are you hoping to receive from this retreat?

Is there anything you’d like us to be aware of to support your experience?

Estimated arrival time:

Tijd

UurMinuten

I confirm that I have shared all relevant medical information

I understand that I participate at my own risk

I accept responsibility for any damage or injury caused to third parties

I confirm that I am responsible for my own insurance

I have read and agree to the Terms & Conditions

How would you like to feel when you leave the retreat?

Thank you for taking the time to share this with us. We’re preparing your stay with care and look forward to welcoming you soon.