Full Name *

Your Email Address *

Partner's Name *

Partner's Email Address *

Address *

Phone Number *

Name of Emergency Contact *

Relationship to Emergency Contact *

Phone Number of Emergency Contact *

How long have you been together? *

Do you have any children? List ages.*

Have you been in couples counseling, sex therapy or another group process before? Please, describe. *

How did you hear about this retreat?

Did anyone refer you? If so, whom?

By submitting this contact form (or registration form) you are agreeing to share all information held within it with Hakomi Mallorca staff and trainers. We will use this information exclusively within our organization for our own administrative records, program planning, and to send you service-related communications.

Yes, I agree