Welcome to our tribe

We're very excited to have you join us here at Akasha Wellness Retreat. Our entire concept and philosophy is centred around health & wellness and this is in everything from the facilities of the retreat to the food & therapies provided. In order to best help on an individual basis please fill in the questionnaire below which indicates to us your current health status and how we can help during your retreat. 

It is worth mentioning that your questionnaire is confidential and only shared with your approval with our staff members which include our yoga teachers, massage therapist & medical advisors. 

Based on your questionnaire we will advise on specific foods, specific postures during your yoga practice & style of yoga that you would benefit from personally. 

You may also receive correspondence from our medical advisors with links to articles that may be of interest to you. 

This does not constitute medical advice and we always recommend to discuss medical issues with your physician before and after a retreat. 

 

Health Questionnaire

Name *
Name
Please indicate your level of yoga practice
How many days per week do you practice yoga? ( Including self-practice at home)
Do you do any other type of regular exercise?
Root Chakra Balance
The following details will indicate to us if you currently have an inbalance in your root chakra.
Sacral Chakra Balance
The following details will indicate to us if you currently have an inbalance in your sacral chakra.
Solar Plexus Chakra Balance
The following details will indicate to us if you currently have an inbalance in your solar plexus chakra.
Heart Chakra Balance
The following details will indicate to us if you currently have an inbalance in your heart chakra.
Throat Chakra
The following details will indicate to us if you currently have an inbalance in your throat chakra.
Third Eye Chakra
The following details will indicate to us if you currently have an inbalance in your third eye chakra.
Crown Chakra Balance
The following details will indicate to us if you currently have an inbalance in your crown chakra.
Are you happy to share this with the relevant staff on the retreat?