A retreat

UNBECOMING

A small step back to yourself

This isn't an application.
It's just a quiet pause…
to check in with yourself,
and for me to understand you a little better.

There are no right answers here.
Just honesty.

Section 1 — You

Name

Age

City

Contact number

Section 2 — Entry

What made you pause
and consider this retreat?

Section 3 — Current state

How have you been feeling lately?

Mentally tired Emotionally overwhelmed Disconnected from myself Functioning, but something feels off Just exploring / curious Other

Section 4 — Depth

If you slow down for a moment…
what feels most heavy right now?

Section 5 — Relationship with rest

Do you feel like you know how to truly rest?

Yes Not really I don't remember what that feels like

Section 6 — Intention

What are you hoping
this space might give you?

Section 7 — Comfort with space

How do you feel about
silence and unstructured time?

I'm comfortable with it I'm curious, but unsure It feels uncomfortable

Section 8 — Practical

Which location are you considering?

Goa May 7–10 Dharamshala June 25–28 Not sure yet

Section 9 — Closing

Is there anything you'd like
me to know about you?

One last thing

Would you like me to reach out personally
after reviewing this?

Yes No

Take all the time you need.
There's no rush here.

Something didn't go through. Please try again in a moment.

✓

Thank you.

Thank you for taking a moment with yourself.

I'll go through this personally
and get back to you soon.

No rush on anything.
Just sit with how this feels.