Évaluation sanitaire - Aleenta Resorts

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Home
Aleenta
akyra
- Bangkok
Bien-être AYURAH
- Retraites AYURAH
- Atelier AYURAH
Fond de teint bleu pur
FR
- EN
- CN
- DE
- KO
- RU

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Évaluation de la santé

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Privacy & Care*

All information shared is treated with absolute confidentiality and is used solely to create your personalised wellness journey.

Nom*

Nom de famille*

Numéro de téléphone

Nationality*

Pays

E-mail*

Age Range*

Please provide us with the following information

Under 30

30-39

40-49

50-59

60+

Genre

Mâle

Femelle

Je préfère ne pas partager

Preferred Language of Communication

English

German

Thai

Autre

Destination préférée

Aleenta Phuket-Phang Nga

Aleenta Hua Hin-Pranburi

Aleenta Chiang Maï

What is the main reason you are considering a wellness retreat at this time? (Select up to 3)

Stress, burnout, or emotional fatigue

Weight management

Detox & gut health

Hormone balance

Longevity & healthy ageing

Pain management

Fitness & performance

Mental clarity & emotional reset

Sleep optimisation

Recovery after illness or surgery

Spiritual growth & self-enquiry

Preventative health screening

I’m not sure – I’d like expert guidance

How would you describe your current health and energy levels?

Excellent – proactive optimisation

Good but I want improvement

Frequently tired or stressed

Experiencing ongoing symptoms or imbalance

Recovering from a health issue

Autre

Do you have any of the following? (Check all that apply)

Hormonal imbalance

Thyroid condition

Diabetes / prediabetes

High blood pressure

Digestive disorders

Autoimmune condition

Chronic pain

Cancer history

Cardiovascular condition

Mental health challenges

None

Prefer to discuss privately

Are you currently under medical supervision?

Oui

Non

Have you attended a wellness or medical retreat before?

First-time guest

Occasional retreat guest

Experienced medical-wellness guest

High-performance optimisation client

What best describes your ideal experience?

Gentle, restorative & nurturing

Balanced wellness with structure

Intensive medical-wellness optimisation

Psychological & emotional work

Physical challenge & movement-based

Integrative (mind, body & medical)

Therapies & Activities of Interest

Select all that appeal to you

Medical diagnostics & longevity testing

Detox & gut reset

IV therapy & biohacking

Qigong / breathwork

Sound healing

Fitness & strength training

Muay Thai / boxing

Cycling / hiking / nature immersion

Psychological coaching / rewriting experience

Traditional spa & healing therapies

Nutritional therapy & functional nutrition

Sleep therapy & recovery

What is your preferred retreat duration?

3-4 Nights

5-7 Nights

8-10 Nights

10+ Nights

I'm flexible

Preferred month(s) of travel

Budget Range (per person, per night)

This helps us match programs accurately.

THB 15,000 – 25,000

THB 25,000 – 40,000

THB 40,000 – 60,000

THB 60,000+

Prefer not to disclose

Accommodation Preference

Private pool villa

Ocean/sea-view suite

Garden or nature view

Best available within my program

Will you be travelling:

Alone

As a couple

With friends

With family

Structure vs Flexibility

Which do you prefer?

Fully structured daily programme

A balance of structure and free time

Mostly free time with selected sessions

Completely tailor-made

Personalisation

Would you like a standard retreat recommendation or a fully tailor-made program?

Recommend the best existing AYURAH retreat for me

Design a fully personalised retreat for me

Not sure – please advise

Dietary Preference

Plant-based

Pescatarian

Mediterranean

Ayurvedic-inspired

No specific preference

Autre

Food allergies or sensitivities

Is there anything else you would like our medical-wellness team to know?

Consentement*

I consent to being contacted by the AYURAH Wellness team for personalised retreat consultation.

Consentement*

I understand that this assessment does not replace medical diagnosis.

Consentement*

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