Name
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First Name
Last Name
Phone
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What draws you to The Power Within retreat right now?
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What are you hoping to shift, transform, or explore during this retreat?
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Have you explored retreats, workshops, or inner practices before? If so, what was your experience?
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What would an ideal outcome from this retreat look like for you?
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Are there any challenges you’re currently navigating that you’d like support with?
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How do you currently support your wellbeing (e.g., movement, meditation, therapy, community)?
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Is there anything you’d like us to know about you so we can support you best during the retreat?
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Have you attended a retreat before?
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How familiar are you with practices like yoga, meditation, or breathwork?
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What feels most true about where you are right now?
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What kind of environment helps you feel most supported?
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What room are you interested in?
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We have a few options and so to avoid double booking this is important!
Preferred Date
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Are you looking to join our April offering or October offering?
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DD
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Do you have any dietary requirements or allergies we need to know about?
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Do you have any injuries we need to know about?
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Please let us know if you have any of the following contraindications for the Breathwork
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Super important to be very open here - we are working with a very powerful modality and we want to make sure that you are safe.
Please be sure to read the following Therapeutic Breathwork Waiver
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https://thexbreath.com.au/breathwork-waiver
How did you hear about The Power Within retreat?
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