Name
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First Name
Last Name
Phone
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Email Address
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Home Address
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Date of Birth
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How did you hear about Repose retreat?
Nurturing mini massage treatments
We have created time during our retreat for a deeply nurturing bespoke treatment focused on one area of the body.
It would be great to know in advance if you are drawn to a particular area of the body so that Martha can prepare for your treatment in advance.
Gut health, nutrition & herbs
Please use the box below to inform Jo of any specific concerns or queries you may have around gut health, fermented foods or medicinal herbs in relation to attending Repose.
CURRENT HEALTH CONSIDERATIONS
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Please do inform us if you have any of the below conditions/considerations.
We would be grateful if you could expand on this in the box below, giving more detail on how this effects you in your day to day life and how we can support you during the retreat.
Key health symptoms, conditions, injuries and concerns
Please detail here any further information that you feel is helpful for us to know prior to joining us on Repose retreat
Are you happy for photo's or video's, that include you from Repose 2022, to be included in our future marketing?
Client Disclaimer
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Please read the following carefully and only click that you agree if you are in full agreement:
• I understand that the classes, workshops and treatments offered on Repose retreat are not a substitute for medical care.
• I will consult my GP or Consultant before Repose retreat if I have any condition that may require particular considerations. It is my responsibility and not that of the therapists/practitioners/teachers to consult my GP or Consultant.
• I will notify you in advance of the start of Repose of all known relevant medical conditions and injuries.
• I will inform you at the earliest opportunity of any changes in my health and medical condition. I understand that there shall be no liability on the your part should I forget to do so.
• If I experience pain or discomfort during a workshop or treatment, I will immediately inform you so that postures/pressure/techniques can be adjusted to my level of comfort. I will therefore not hold you responsible for any pain or discomfort that I may experience during or after a session that could have been avoided through communication and adapting to your needs and preferences.
Is there anything else that you would like to add or make us aware of?
Thank you for submitting this health and well-being questionnaire in preparation for joining us on Repose retreat. It will help us to prepare the space, our classes, workshops and treatments for you with your health and well-being in mind.
With warmth.
Jo, Charlotte & Martha
