The Detox Retreat Application

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Name: *

What mental health issue are you facing? *

How long have you been feeling this way? *

What kind of help have you received already? *

Have you ever spent over $2000 investing in your personal mindset work?

Yes

Clear selection

Is that something you're willing to do?

Yes

Clear selection

Have you attended one of my events/retreats before?

ARISE

I've done one of your courses

Another retreat

Are you able to attend October 10th-13th in Southern Utah? *

Yes

Best email to contact you if you are approved? *

Who did you hear about The Detox Retreat from? *

On a scale of 1-10 how ready are you to change?

Clear selection

Phone Number

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