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The Rooted and Rising Retreat application
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Name
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Date of birth
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Mailing address
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Email address
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Phone number
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Emergency Contact
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What are your current health goals?
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What selfcare tools are you currently using?
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What "labels or diagnoses" have you been given by a doctor?
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Are you currently taking any medication?
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What does an average night of sleep look like?
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What does an average day of food and drinks look like?
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What do you hope to gain from this retreat?
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Please list anything else you would like me to know
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