The Reimagined Life Retreat

Participant Agreement

Thank you for joining us. Prior to your 1:1 coaching session with Fiona we'd appreciate you answering a few questions about yourself. We'd also ask you to confirm that you agree to our terms and conditions.

First name:

Last name:

Known as (if different):

Sex at birth:

Female

Male

Prefer not to say

What gender do you identify as now?

Male

Female

Non-binary

Prefer not to say

Date of birth:

Email *

Address

City

Postal code

Phone *

If you had to name one thing that is your priority in the next 12 months, what would it be?

What motivated you to join The Reimagined Life Retreat?

What outcomes are you hoping to achieve for yourself by being on the retreat?

Are you currently taking any medications

Yes

If yes, please provide details of the medication(s) you currently take:

If you're comfortable to do so please tell us more about your cancer journey including how far post treatment you are

Is there anything that could stop you committing to your emotional recovery right now?

When it comes to achieving what you really want for yourself, what do you feel are the biggest barriers you face?

Activities

During the retreat we'll be using a number of different techniques and tools as part of the healing process. Please let us know if you have or have any any of the following:

Epilepsy

Heart disease

Depression

Generalised Anxiety Disorder

Post Traumatic Stress Disorder

Bipolor Disorder

Schizophrenia

Border Personality Disorder

Experience of psychotic episodes

Any other psychiatric condition

Do you have, or have you had, any of the conditions listed above?

Yes

If you answered yes above please provide details:

Sound healing:

Do you suffer from any conditions that affect your ability to hear or have any sensitivities in hearing?

Hypnotherapy:

Can you confirm you are able to participate in this type of activity

Yes

Finally, please confirm that you agree to our participant terms and conditions:

I agree to the retreat terms & conditions provided by the Kora Coaching and Therapy and confirm that I am responsible for making sure I am fit and well enough to participate.

Thank you

We'll be in touch with the next steps over the next fews months including how to book your 1:1 session with Fiona. We'll also be sending you a health questionnaire that we need you to complete prior to the retreat.

If you feel there is anything else we need to know please get in touch by emailing us at [email protected].

We're happy to help - our aim is to make sure you feel completely at ease.

Warm wishes

Fiona and the Kora team