The Productive Learning Retreat Survey

Your Adventure on Kauai

Aloha!

Dolphin Touch Wellness Center is partnering with Productive Services to provide services and support for your upcoming retreat on Kaua'i, Hawaii.

Dolphin Touch Wellness Center is a place for Transformation, Illumination, and Healing.

What are we here to do? Dolphin Touch Wellness Center is here to help provide a pathway/vehicle for you to move into the next step on your spiritual path, to teach, to learn, to be a cheerleader, and a co-celebrator of your achievements. More than anything, we want you to find true joy and happiness, open your heart to love, see your dreams unfolding, and have a life that is full of adventure!

It would be our immense pleasure and honor to be co-creators in your reality, to witness the transformation into the new you, to play in the vortex of infinite possibilities, and to hear the wonderful stories of success you will be sharing with us!

For your Women's Retreat, you will have an opportunity to receive some of our services after 4 pm on Thursday, April 27th, and before 1 pm Friday, April 28th should you choose to schedule those for yourself. The time is available for you. This will not interfere with the workshop portion of the retreat, and we will do our best to accommodate based on a first come first serve basis.

Please check your desired services and times below. We will invoice you separately which will need to be paid a week in advance of your arrival for us to adequately prepare. Also note, you will need to arrange transportation to our facility in Kapaa which is a short 9-minute drive. (4544 Kukui Street, Kapaa)

If you do not desire any extra services, please continue to fill out the form for our records.

Aloha and Welcome,

Jeanne Marie Russell, Reiki Master, Owner and Creator of Dolphin Energetics™

1.Please fill out the information below:

First Name:

Last Name:

City, State or Country:

Phone Number:

Email Address:

2.We have a number of services available. Please choose all services that you are interested in receiving. (All Sessions are 60 Minutes)

Dolphin Energetics™ on the Mermaid Table Receive the healing energy of the dolphins while you lay on the mermaid table (a water massage table.) Feel yourself letting go and connecting with the ultimate state of relaxation. Clear your chakras, connect with the aquatic angels, and open up to infinite possibilities! ($245)

Luxurious Hawaiian Massage with a Male therapist A classic relaxing massage using gentle long smooth strokes to soothe aches and pains, and relieve stress and tension. ($145)

Luxurious Hawaiian Massage with a Female therapist A classic relaxing massage using gentle long smooth strokes to soothe aches and pains, and relieve stress and tension. ($145)

Intuitive Reading for the Next Step on Your Spiritual Path See what the cards have to say about Relationships, Health, Life Purpose, Past Life, and more! Get clarity on the next step on your spiritual path. ($155)

Reiki/Sound Therapy with Essential Oils Reiki is Energy Healing and Intuitive Reiki opens your third eye with each session to help you come back to yourself. With each session, you become more in alignment with your intention, your body, and your higher purpose. ($125)

Far-Infrared Red Amethyst Biomat Bed This is a therapeutic session on the Amethyst Biomat Bed. Soothing meditative music is played while you enjoy the healing properties of Negative Ions and Far-Infrared Rays. ($75)

Detox Ionic Foot Bath An ionic foot detox works by pulling the toxins out of your body through your feet. A safe and relaxing way to clear toxins out of the body. Detox Ionic Foot Bath ($65)

Other (please specify)

4.What is a comfortable level of physical activity for you?

Gentle - Strolling, walking, driving

Moderate -slow hiking, bicycling, dancing, kayaking

Vigorous -jogging, running, fast hiking

Other (please specify)

5.Are you here for physical, spiritual, and/or emotional healing or just to have fun in paradise? Check all that apply.

Physical Healing

Emotional Healing

Spiritual Healing

Just to have fun in Paradise!

Other (please specify)

7.What about yourself would you like to change/improve more than anything else?

8.If your could draw your fantasy life, what would it look like?

9.Anything else you want to share with us?