Apply now Please note that the information you provide here will be protected and treated with the utmost confidentiality. These questions help me provide you with the safest environment and highest level of care I can. It is essential to the process that you answer with openness and honesty.
Emergency contact name
Emergency contact phone number.
Do you have any allergies?
How many days you would like your retreat to be? * Required
Are you currently taking or have you recently stopped taking (within the last year) any prescribed medication or anti-depressants?
How many alcoholic drinks do you normally consume each week?
Have you ever used street or recreational drugs (including Marijuana)?
Have you ever been diagnosed with, or treated for a drug or addiction? Please list any other addictions you have had or currently have.
How ready you feel to hear truth and face yourself?
What is a painful truth you have recently realized about yourself or your behavior?
How do you typically react when a coach or therapist challenges a belief you hold or gives you 'tough love' feedback?
Are you ready to invest in changing your life? Do you have a budget for it?
Which retreat are you interested in? In which country you would like to have the retreat? CONTINUE
