Client D Form Health Retreat Application Form

So we can support you best on your health journey please take time to reflect on the following questions and indicate the following:

Is your concern affecting you at the moment? If so please describe the feeling and how often you feel this way.

If your/some of your concerns have been in the past please describe when, how often and for how long they have been affecting you.

Place of Birth & Time (if you have it)

Reason/s for application?

What is your primary goal or concern physically, emotionally, mentally?