Care & Love Form

Hello beautiful Soul! We are honored to be welcoming you in To The Depth Of You Retreat on September 2023! Please take your time to read and answer this intake form. Your responses enable us to get a better understanding of your needs and how we can best support you on this beautiful journey.

The information you will share on this form is confidential and will not be shared with anyone. We are very excited to host you for days full of healing, connection, and heart-warming conversations!

P.S. You can answer this form in Arabic or English. Whatever is easier and best expressive to you.

With Love,

INTHEINNER Team

Name

First Name

Last Name

1- Preferred Name : اسم الدلع ؟ :) تحبين نناديك فيه؟

2- What you wish to receive from this retreat experience?

3- Emergency contact.

4- How often do you practice yoga?

5- Do you have any current physical injuries or medical issues that impact your yoga practice or any body movement?

(Examples, back or knee injuries, recent surgeries) please be specific.

6- How would you rate your current level of stress?

( 1 is the least, 5 is the highest)

7- How would you rate your quality of sleep?

(1 is the poorest, 5 is the best)

8- Please share any experience you may went through that caused emotional pain and left an impact on you today.

9- Have you been in psychotherapy before? Or have you done any psychological work of any sort? if yes, was it effective? or not?

Please explain in details.

10- Do you struggle with interpersonal relationships of any kind?

(ex. intimate relationship, family relationships, friendship, work.. etc). Please feel free to share in general or details, all are welcomed.

11- What is the most thing that is keeping your mind busy? Something that is causing you stress and discomfort of any sort.

12- Are you taking any mental health medication in the past or in the current time?

Please be specific in name, time of use, reasons, effectiveness.

13- Any other medication?

Please be specific in name, time of use, reasons, effectiveness.

14- Do you have any life-threatening food allergies and/or food intolerance we should be aware of?

Please share any specifics related to food and meals that you want us to know.

15- Is there anything you feel that we should know about you?

16- Please write a personal letter from you to the other participants in the retreat. This can be something motivational or a deep reflection of your beliefs, a lesson you learned. Or you can share a quote, a pome, a song lyrics, really anything meaningful to you.

[We will share this in the retreat so you have the choice if you want us to mention your name or keeping it anonymous, please let us know]