Nature Immersion Inquiry

First name

Last name

Birthday

Month

Day

Year

Email

What’s drawing you to a nature-based retreat at this time?

What feels most alive, challenging, or unresolved for you right now?

Have you spent extended time in undeveloped or off-grid environments before?

Yes

Somewhat

No

Are you currently navigating any physical, emotional, or psychological conditions that would require additional support during an immersion?

Yes

No

What helps you feel grounded, safe, or regulated when things feel intense?

Is there anything you’d like me to know as I consider your inquiry?

Heart of Lumi