Health Check Form Questionnaire

Confidential Information

The following confidential information will be treated with strict confidence. The information is required for your safety and to benefit your health. There may be certain contraindications, which will require special attention and/or further discussion. It may be necessary to consult with your Medical Practitioners before the start of any of our retreat or online programs. Take your time to fill out this health Questionnaire with complete honesty, a thorough health screening can help us to personally tailor together the most efficient retreat or online wellness program. 

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