GENERAL SELF ASSESSMENT

If you’re concerned about your eating habits or body image, our self-assessments can help you better understand and reflect on what you're experiencing and find any help you may need.

Please answer the following 8 questions for the self-assessment:

OVER THE LAST 2 WEEKS, HAVE YOU NOTICED YOURSELF:

Thank you for completing the self-assessment

Based on your answers, we recommend that we call or email you with further assistance.

Alternatively, call us on 031 761 8766.

Start a WhatsApp Conversation With Us

RSVP Form

We look forward to hosting you for an evening of insight, collaboration, and connection. Please confirm your attendance below.

Progress

Progress

I declare that the information provided in this application is true and correct to the best of my knowledge. I understand that admission to Medilution Wellness Retreat is subject to a clinical assessment by qualified professionals. I hereby consent to undergo any necessary medical, psychological, and therapeutic evaluations required to determine my suitability for the program. I also acknowledge that all personal and medical information will be kept confidential in accordance with applicable privacy laws and ethical standards. By signing below, I agree to abide by the rules, regulations, and guidelines of Medilution Wellness Retreat and understand that failure to comply may affect my participation in the program.