Find Your Perfect Retreat "*" indicates required fields Step 1 of 8 12% Before Starting Please provide us with the following information:Full Name*Email* Phone / WhatsappCountry of Passport / Residence* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Age Range*Please provide us with the following information Under 30 30-39 40-49 50-59 60+ Preferred Language of Communication English German Thai Other When are you hoping to travel? Within 1 month 1-3 months 3-6 months 6+ months / just exploring Is this your first stay with Aleenta / AYURAH? Yes No Preferred destinationWhich destination are you most interested in? Aleenta Phuket-Phang Nga Aleenta Hua Hin-Pranburi Aleenta Chiang Mai Not sure yet Length of StayHow long would you ideally like to stay? 3 Nights — Reset 5 Nights — Transform 7+ Nights — Deep Dive 14+ Nights — Life Recalibration Your Primary Wellness GoalsSelect as many as apply. Available programmes may vary based on length of stay. Longevity & prevention Cognitive function & mental clarity Stress management & nervous system reset Healthy weight & metabolic balance Detox & digestive optimisation Hormonal balance Sleep improvement Energy & fatigue recovery Emotional wellbeing Pain management (muscular / joint) Holistic support for bones & joints General wellbeing & relaxation How often do you exercise? Never Once a week 2-3 times per week 4 or more times per week Your current stress level: Low Moderate High Do you experience muscular or joint pain? Never Occasionally Often Quality of your sleep: Very good Good, with room for improvement Far from optimal Digestive comfort (bloating, constipation, discomfort): Never Occasionally Often Mental clarity & focus: Very good Good, with room for improvement Not so good Far from optimal Recent fatigue or lack of energy? Yes No Frequent tension in neck, back or shoulders? Yes No Current mood / emotional wellbeing: Very good Good, with room for improvement Not so good Far from optimal Your Preferred Retreat Experience StyleWhich type of experience do you feel most drawn to? (You may choose more than one) Purely Holistic — yoga, meditation, massage & natural healing Active & Movement-Based — fitness, Muay Thai, cycling & training Science-Informed Wellness — lab insights, body scans, IVs & biohacking A Balanced Blend — spa therapies with guided medical & longevity insights Gentle Medical AwarenessDo you have any diagnosed medical conditions we should consider when designing your programme? Yes No Other Dietary NeedsAny important dietary preferences, allergies or sensitivities?Additional NotesIs there anything else you would like our wellness team to know? Consent* I understand that my Tailor-Made programme may be reviewed and adjusted by the AYURAH wellness and medical advisory team to ensure safety and optimal results.Consent* I accept Aleenta’s Privacy & Cookies Policy and consent to be contacted for my personalised retreat consultation.
