Who referred you?

How did you find out about Rozaliya’s Retreats?

Do you meditate?
YesNo

If so, what kind of meditation do you practice?

How long have you been practicing?

Have you attended spiritual retreat before?

What inspired you to sign up for this spiritual work?

What is the issue you want to transform in your life?

Are you experiencing any health or mental issues at this time?
YesNo

If yes, please describe what health or mental issues you are experiencing.

Are you feeling inspired to transform your life?
YesNo

What do you want to create for your future?

What do you hope to gain from our spiritual work sessions?

Please leave this field empty.

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