Submit Your

Weekend Intensive Retreat

Intake Form

. LOGISTICS .

Full Name *

Email *

Phone *

. VALUES & INTENTIONS .

What would you most like to focus on? *

What would you most like to get out of our time together? *

What would you most like to transform? *

Why would you like to work with me? *

. ABOUT YOU .

What are you passionate about? *

What do you love about yourself? *

In what ways are you an epic badass? *

What are your biggest challenges, currently? *

What victories or wins have you celebrated recently? (or could have celebrated?) *

What self and/or spiritual development work have you already done? And for how long? *

Which of the following techniques or practices are you most interested in me using inour work together?

Which of the above techniques and practices have you already worked with? And for how long? *

What book, teacher or e-learning program most inspired you to continue with your personal and spiritual development? *

. ADDITIONAL PLEASANTRIES .

In addition to the work we do together while you’re here, you will receive some bodywork and/or energy healing from a licensed practitioner. We’ll spend some time in nature – walking in the woods, hills or at the beach. You’ll have reflection time – for writing in your journal, and/or creating contemplative art pieces. We will also enjoy highly nutritious and delicious meals together.

. LOCATION .

Cleveland, Ohio
You will travel to Cleveland, where we will work together in-person at my home. During the weekend, you can choose to either stay on-site in my guest quarters or at a nearby hotel.

. COST .

Our weekend together will start on Friday afternoon/evening and go through Sunday afternoon/evening.
My fee is $1995. Your travel expenses will be additional, as well as any hotel costs you may incur.
To reserve a weekend with me requires a down payment of $995. The balance is due at the conclusion of the retreat weekend.
*Deposit non-refundable 30 days prior to first date reserved.

. TIMING .

Please specify 3 weekends that would work for you to get together in the next few months: *

Date #1
Date #2
Date #3

. AGREEMENT .

Are you in agreement to sign a form of confidentiality and a disclaimer? (We’ll take care of that when you arrive.) *

Yes

. ANYTHING ELSE? .

Is there anything else you would like me to know at this time? Also, feel free to use this space if needed for longer answers from the questions above.

. RESERVE YOUR WEEKEND DATES .

Peggy will call you in the next day or two to confirm your weekend-date. Then she will email you a link so you can make the down payment and reserve a spot on her calendar.

By submitting this form, I give my consent for Peggy O’Neill & Peggy Speaks to contact me by text, call, or email. I understand I can reply STOP or unsubscribe at any time. I also agree to the Privacy Policy and Terms of Service.*

Submit Your

Weekend Intensive Retreat

Intake Form

. LOGISTICS .

. VALUES & INTENTIONS .

. ABOUT YOU .

. ADDITIONAL PLEASANTRIES .

. LOCATION .

. COST .

. TIMING .

. AGREEMENT .

. ANYTHING ELSE? .

. RESERVE YOUR WEEKEND DATES .

Submit Your

Weekend Intensive Retreat

Application