Welcome! We'd love to help you achieve your wellness goals.

Please complete the questions below. We're excited to hear about your challenges, and your goals! After you click 'submit', a Wellness Coordinator will reach out and work with you on next steps.

First name

Last name

Age

BMI

I've tried these healing therapies and WOULD do them again...

I've tried these wellness treatments but would NOT do them again...

I'm curious and/or interested in these healing modalities...

I'd like to target the following physical issues:

I struggle with food intolerances or food allergies

I'd like to target the following lifestyle areas (optional):

I'd like to target the following mental/emotional issues:

How would you describe your overall health?

Up and down

Challenging, and I need lots of encouragement.

Tough, but I balance it well with occasional supports.

Good, needs small tweaks

Poor - Needs Major Changes

Great, but I'm always trying to improve!

My monthly health and wellness budget is...

Please include the amount you would spend on supplements, prescriptions, copays, gym memberships/equipment, alternative therapies, and preventative care.

My top priority for health/wellness is...

What I hope to achieve in my wellness is...

Email

Phone

If planning a tailored retreat, please share dates that would be best for you: