Dietary Preferences & Habits"*" indicates required fieldsURLThis field is for validation purposes and should be left unchanged.Preparing for Your StayWe look forward to welcoming you to Inner Realms Center.This short form helps our team prepare meals, hydration support, and your room environment in a way that supports your comfort and stability during your stay.Please complete all sections thoughtfully.Full Name* First Last Age*Please enter a number from 1 to 120.Email* Phone Number*Dietary Preferences & HabitsDescribe your typical daily meals and eating schedule.*Do you follow any specific dietary pattern or have any food preferences?*For example: vegetarian, low sugar, gluten-free, etc.Are there any comfort foods or familiar foods you particularly enjoy?Electrolyte SupportPreferred electrolyte drink* Coconut water Gatorade Electrolyte tablets No preferencePreferred Gatorade color/flavorIf you prefer a specific electrolyte tablet brand, you are welcome to bring it with you, as local availability may be limited.Vegetables & SaladsAre you comfortable regularly eating vegetables and salads?* Yes Somewhat NoAny preferences regarding vegetables or salads?Favorite FoodsAre there any foods you particularly enjoy that feel supportive or comforting?We will do our best to accommodate reasonable preferences when possible.Food DislikesAre there any foods you strongly dislike or prefer to avoid?*Dietary Safety — Allergies & Restrictions⚠️ This section is important for your safety. Please complete it carefully.Please list any food allergies, intolerances, or medically necessary dietary restrictions.*Do you have any medically diagnosed food allergies?* Yes NoPlease describe the allergy and its severity.Cultural or Religious Dietary RequirementsDo you follow any religious, cultural, or ethical dietary practices we should be aware of?* Yes No Prefer not to sayPlease describe any religious, cultural, or ethical dietary practices our kitchen team should respect.Examples may include halal, kosher, vegetarian for religious reasons, fasting practices, or other food-related observances.Preparing for Your StayI understand that caffeine (including coffee and energy drinks) should be discontinued prior to arrival and is not used during the stay.* I understand and agreeI understand that alcohol and stimulant substances should be avoided for at least 7 days prior to arrival.* I understand and agreeI understand the remaining program balance is due in USD cash on the day of arrival.* I understand and agreeI understand that obtaining medical travel insurance is strongly recommended. I understand and agreePersonal Comfort ItemsIs there anything that would help make your room environment more comfortable for you?Examples: meaningful objects, reading materials, etc.Intention SettingIf you feel called, you are welcome to share any intention you are holding as you prepare for this experience.This is optional and for supportive awareness only.Final ConfirmationI confirm that the information provided is accurate to the best of my knowledge.* I confirmParticipant SignatureInner Realms Center honours the confidentiality of information obtained about clients. Any information given here is strictly confidential.
