First Name
Last Name
Email
*
Guest - Phone / WhatsApp
Guest - Country
Guest - Retreat Interest
Release (Separation & Heartbreak)
Reset (Burnout & Exhaustion)
Return (Grief & Loss)
Reclaim (Identity & Purpose)
Not sure yet
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Guest - Preferred Dates
Guest - Villa Preference
Garden Suite - Solo
Garden Suite - Shared
Sanctuary Suite - Solo Premium
Sanctuary Suite - Shared
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Guest - Payment Plan
Pay-in-Full (save $2,000)
Half-Down (save $1,000)
Standard
Not decided
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Guest - How Heard About Us
Instagram
Referral
Google search
Kyla / Medical Tourism
Website
Word of mouth
Blog article
Other
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Guest - Referral Source Detail
Guest - Prior Retreat Experience
Yes - plant medicine retreats
Yes - wellness retreats (no plant medicine)
No - first time
Rather not say
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Guest - Goals
Guest - Dietary Restrictions
None
Vegetarian
Vegan
Gluten-free
Nut allergy
Shellfish allergy
Other
Guest - Medical Conditions
Guest - Emergency Contact Name
Guest - Emergency Contact Phone
Guest - Emergency Contact Relationship
Guest - Add-Ons Requested
Extra Thai Massage ($80)
Hot Stone Therapy ($100)
Private Session with Justin ($200)
Thai Cooking Class ($75)
Temple/Waterfall Excursion ($60)
Sunset Boat Tour ($120)
Night Market Tour ($50)
Muay Thai Session ($60)
Premium Photo/Video ($350)
30-Day Virtual Integration ($150)
IV Therapy
Peptide Services
Detox Protocol
Reiki
Acupuncture