Retreat Intake Form

Retreat Attendee Questionnaire

First Name

Last Name

Email

Phone/Mobile

Do you have any dietary restrictions or food allergies?

Emergency Contact Name

Emergency Contact Phone/Mobile

Do you snore?

Yes

No

Unsure

Are you comfortable sharing a room with a person of the same gender?

Yes

No

Prefer private room if available

Do you have a preferred roommate? If so, write their name here

How long have you been carnivore or animal-based?

What are your primary health goals?

Weight loss

Metabolic health

Energy

Autoimmune support

Body composition

Community

Learning

Biohacking

Other

What are you most excited about at the retreat?

T-Shirt Size

I understand retreat tickets are nonrefundable

Yes

No

Is there anything else we should know?

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