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Functional Medicine Retreat Application - Kona, Hawaii
1.
Why do you want to attend this retreat? What attracted you to the retreat?
2.
Please list your top 3 symptoms or conditions you would like to change and have addressed at this retreat.
3.
How would you rate your willingness to make change to reach your health goals?
0
1
2
3
4
5
6
7
8
9
10
4.
Do you find dealing with other people's personalities a challenge, or do you find yourself a 'go with the flow' type of person?
Dealing with other people's personalities is a challenge
Go with the flow type of person
5.
Do you have dietary restrictions? Are there foods you do not like?
6.
Are you interested in participating in extracurricular activities such as walking, hiking (relatively steep terrain), snorkeling, boogie boarding, surfing, and sightseeing? Select all that apply.
Walking
Hiking
Snorkeling
Boogie boarding
Surfing
Sightseeing
None
7.
How did you hear about this retreat?
Social Media
Friend or Family
Website
Email
Other
8.
What are you hoping to get out of this retreat?
9.
Are you familiar with Functional Medicine or have a science background?
Yes
No
*
10.
Have you had any Functional Medicine labs done?
(Required.)
Yes
No