Request a Personalized Retreat

Personal Information

Your Full Name

Phone (Prefix country code)

City & State

Your Specific Challenge

Physical Pain & Mobility Issues

Stress-Related & Emotional Pain

Relationships & Emotional Wellbeing

Healing from Heartbreak / Divorce Relationship with Self Struggles with Intimacy & Emotional Connection Feeling Disconnected in Relationships Navigating Loneliness & Isolation Trust Issues & Emotional Wounds Family Conflicts & Unresolved Pain Other

Life Circumstances Affecting Your Wellbeing

Your Ideal Retreat Experience

What are you hoping to gain from this retreat?

Have you tried any healing modalities before? If yes, which ones?

Are you comfortable with immersive, guided experiences

Accessibility & Logistics

Do you have any physical limitations or accessibility needs?

Preferred Retreat Location

Do you have any dietary restrictions?

Group & Capacity Preferences

Would you prefer a

Are you open to being grouped with individuals facing similar challenges?

Yes No

Final Step

Would you like to receive updates on future personalized retreats?

Yes No

Anything else you’d like to share?

I confirm I have read and agree to the terms and conditions, including the cancellation policy, data protection guidelines, and general terms.

Disclaimer While some of our buddies may be licensed practitioners in specific states, not all compassionate buddies hold a professional license. Antaha does not make any claims regarding the licensing status of our compassionate buddies. For more information about your buddy's credentials, please reach out to us at hello@antaha.org.