Eyes of Power Retreat Questionnaire for screening purposes

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Retreat Questionnaire

This is an opportunity for us to get to know one another and connect. Your responses helps us to shape the retreat into the kind of experience that is tailored to resonate deeply because it touches on your personal passions and addresses your needs.

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Name *

Email *

Phone *

Please select the type of retreat you are interested in

Personal Development
Post-truma-care
Organizational Development

Please check all that apply for a personal or organizational development retreat

Gain back control of your life
Conquer your emotions
Minimize the issues in your personal and/or professional relationship
Executive (Managers, Directors,Attorney, Business), incuding small groups and organizations

Please check the post-trauma-care retreat of interest

Women Crusaders
Partner and Spouse
Women in Healing
Friends and Family

Please share any allergies or dietary restrictions you’d like us to know about. Your answer

Please share any medical limitations you'd like us to know about.

Please share any mental health conditions or medications you'd like us to know about

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Location:

276 5th Ave, Suite 704, New York, NY, 10001

Phone:

347-841-6265

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Retreat Questionnaire

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