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About
Work With Me
Testimonials
Insights
Connect With Me
Retreat Intake Form
Name
First Name
Last Name
Email
*
Which city do you live in?
Age
Why are you interested in attending this retreat?
What are you hoping to receive from this retreat?
Have you had any one-one counselling for your loss(es)? If so, for how long?
Do you feel like you can be in a space hearing other people's stories of their loss?
Yes
No
Who is the person that died?
What is their name?
When did this happen?
If you’d like, tell me about your loss.
If you’d like, tell me about your loss.
*
Do you have a yoga practice? If so, what kind of yoga do you practice? (Please note, experience not necessary for retreat)
How did you hear about this retreat?
*
Is there anything else you would like to share with me?
Thank you so much for taking the time to fill out the retreat intake form. I will be in touch soon.
