This is Your Pre-Retreat Questionnaire

Escapada Health & Wellness Retreat Team

Your Health Retreat starts here.

Thank you for choosing Escapada Health Retreat. We look forward to hosting you!  

We invite you to tell us as much as possible about yourself so we can already start individualising your stay with us.

All information is confidential. 

The Escapada Team


Name *
Home Address *
Home Address
Please include country code
Name: Telephone No:
Date/Estimated Time of Arrival
Date / Time of Departure
Medical History
Date of Birth
1. Past or current medical problems
Please tick all that apply and / or use the text box below
2. Other medical problems
If yes to any medical problems, please provide details
3. Any recent surgeries
If yes please provide details
4. Are you taking any medication (or have in the last six months)?
If yes please provide details
5. Are/could you be pregnant now or have you had a baby in the last 12 months?
6. Do you have any food allergies/intolerances/preferances *
If yes please provide details
Reasons for choosing Escapada Health Retreat
Level of Yoga practice
Liability Disclaimer & Notice *
I consult a physician prior to enrolling to practise yoga. Otherwise I assume the physical risk of my own physical condition, past and current medical issues/injuries/illness or medication that may affect me on this retreat. I understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every yoga session. I will not perform any postures to the extent of strain or pain. if at any time during the class, you feel discomfort or strain, gently come out of the posture. I accept that neither the teachers, personnel, nor Escapada and its owners, are liable for any injury, or damages, to person or property, resulting from taking the class or in the future and I use the premises at my own risk.
Booking Terms and Conditions *
I agree to Escapada's Booking Terms and Conditions. Please see website for full Terms & Conditions.