15 Day Program

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1 Welcome

2 Choose Dates

3 Choose Room

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Lodge Rooms - Standard

Air-Conditioned Room Queen & King Single Posturepedic Bed Shared Bathroom We have two Standard Lodge rooms at Misty Mountain Lifestyle...

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AUD $6,700

AUD $6,700

AUD $6,700
Lodge Rooms - Standard

Air-Conditioned Room

Queen & King Single Posturepedic Bed

Shared Bathroom

We have two Standard Lodge rooms at Misty Mountain Lifestyle retreat:

They are located in the main lifestyle centre. The rooms are air-conditioned, have a shared bathroom, one queen bed and one king single bed and include two treatments of choice for each guest (per week).
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Lodge Rooms - Deluxe

Air Conditioned Private Bathroom Queen Posturepedic Bed (King Single Posturepedic Bed if booking for 3)

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AUD $7,700

AUD $7,700

AUD $7,700
Lodge Rooms - Deluxe

Air Conditioned

Private Bathroom

Queen Posturepedic Bed

(King Single Posturepedic Bed if booking for 3)

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Hilltop Room - Deluxe

Air-Conditioned Room Balcony Queen Posturepedic Bed Private Bathroom This unit has two rooms as well as its own shower and...

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AUD $8,400

AUD $8,400

AUD $8,400
Hilltop Room - Deluxe

Air-Conditioned Room

Balcony

Queen Posturepedic Bed

Private Bathroom

This unit has two rooms as well as its own shower and toilet, a queen bed, air-conditioning, and a small balcony with a view overlooking the property. This package includes two treatments of choice for each guest (per week).
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Hilltop Room - Twin

Air-Conditioned Room Balcony 2 Single Posturepedic Beds Private Bathroom Room 7 has its own bathroom, two king single beds,...

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AUD $7,700

AUD $7,700

AUD $7,700
Hilltop Room - Twin

Air-Conditioned Room

Balcony

2 Single Posturepedic Beds

Private Bathroom

Room 7 has its own bathroom, two king single beds, air-conditioning and a small balcony with a view overlooking the property. This package includes two treatments of choice for each guest (per week).
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Hilltop Rooms - Standard

Air-Conditioned Room Balcony Queen Posturepedic Bed Private Bathroom Rooms 8 & 9 – These rooms have their own bathrooms, a...

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AUD $7,700

AUD $7,700

AUD $7,700
Hilltop Rooms - Standard

Air-Conditioned Room

Balcony

Queen Posturepedic Bed

Private Bathroom

Rooms 8 & 9 – These rooms have their own bathrooms, a queen sized bed, air-conditioning and a small balcony with a view overlooking the property. This package includes two treatments of choice for each guest (per week).
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Ensuite Room

Air-Conditioned Room Queen Posturepedic Bed Private Bathroom Balcony

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AUD $7,050

AUD $7,050

AUD $7,050
Ensuite Room

Air-Conditioned Room

Queen Posturepedic Bed

Private Bathroom

Balcony

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Family Units

Air Conditioned Unit Kitchen & Laundry Facilities Comfortable Lounge Queen & 2 Single Posturepedic Beds Private Bathroom This unit has two...

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AUD $8,800

AUD $8,800

AUD $8,800
Family Units

Air Conditioned Unit

Kitchen & Laundry Facilities

Comfortable Lounge

Queen & 2 Single Posturepedic Beds

Private Bathroom

This unit has two bedrooms, a small patio and lawn. This package includes two treatments of choice for each guest (per week).

PLEASE NOTE: We do not recommend these rooms for anyone with restricted mobility.
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4 People in your group

Guest 1		First Name* Last Name* Gender* Email*
Guest 1		First Name* Last Name* Gender* Email*

After completing this form, emails will be sent to everyone in your group to complete their information.

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5 Book Shuttle

One way shuttle Kempsey to MM - arrival

One way shuttle from Kempsey to Misty Mountain Lifestyle Retreat.

AUD $60.00

Select quantity

One way shuttle Port Macquarie to MM - arrival

One way shuttle from Port Macquarie to Misty Mountain Lifestyle Retreat.

AUD $80.00

Select quantity

One way shuttle MM to Kempsey - departure

One way shuttle from Misty Mountain Lifestyle Retreat to Kempsey.

AUD $60.00

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One way shuttle MM to Port Macquarie - departure

One way shuttle from Misty Mountain Lifestyle Retreat to Port Macquarie.

AUD $80.00

Select quantity

Return shuttle Kempsey to MM

Return shuttle From Kempsey to Misty Mountain Lifestyle Retreat.

AUD $90.00

Select quantity

Return shuttle Port Macquarie to MM

Return shuttle From Port Macquarie to Misty Mountain Lifestyle Retreat.

AUD $120.00

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6 Personal Information

Return Guest
Age *	Your age at time of program.
Preferred Name *	This will be the name used for your name badge and timetables etc.
Gender *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Emergency Contact Info *	Please add name. contact number and relationship of emergency contact.
Occupation and length of employment *	eg. nurse - 20 years/office work - 5years/retired/SAHM, etc.
Marital Status *	eg. married/divorced/de-facto/single etc.
Children *
How did you hear about us? *

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7 Arrival Details

Arrival Time *	10:00am 10:30am 11:00am 11:30am Noon I require shuttle transfer Arrival times are for those driving themselves to the retreat - please note we use these arrival times to book in your individual consults. The first consult is 10:30am. If you are being collected by shuttle you MUST choose the '1:30pm - Shuttle' option and please ensure you have entered all details in 'Pick Up Details'.
Shuttle Transfer (strictly 10am-12pm)	Hotel Bus Depot Train Station Airport Please note: Charges will apply for shuttle service.
Hotel Details	Please advise name and address of hotel
Bus Depot Details	Please advise bus depot address and arrival time.
Train Station Details	Please advise arrival time and train station.
Flight Number	Please advise flight number
Flight Arrival Time	Please advise arrival time at airport.
Departing Shuttle Required - STRICTLY 9am Departure	Shuttle will leave Misty 9am sharp. Please take note of travel times to and from retreat when booking return travel.

8 Health Information

Main Health Concerns *
Cancer *
Details *	What type/stage/treatment/other info etc.
Current Stress Levels *	1 - lowest and 10 - highest
Current Energy Levels *	1 - lowest and 10 - highest
Height *	(Centimetres)
Weight *	(Kilograms)
Any metal fillings or root canals in your teeth? *	If none please write NA.
Any breathing or respiratory problems? *	If none please write NA.
How often do you exercise? *
Daily water intake *	(Litres)
Any digestive discomfort/disorders *	If none please write NA.
Regular bowel movements? How many per day? *
Any hormonal discomfort? (PMS, regularity, flow etc) *	If none please write NA.
Have you had any Covid-19 injections? *	If yes, how many?
Have you received any vaccinations other than for Covid in the past 5 years? *	If yes, please list all vaccines you have had.
Do you have any skin conditions? *	If none please write NA.
Do you have any aches/pains or headaches? *	If none please write NA.
Thrush/ Candida *	Thrush Candida NA Please tick relevant box
Have you had any significant exposure to known toxic chemicals, heavy metals, or mould? And if so, what and when? *	Please be as specific as possible to any exposure to the above
Do you have any issues with sleep? *	If none please write NA.
Have you had any surgical procedures? *	If none please write NA.
Do you have pets? If so, do they live in or outdoors? *	If none please write NA.
EMF Exposure *	I live or work near a 5G tower. I sleep near a smart meter. I leave my wi-fi on at night. Other I keep my phone on my person during the day I work on devices majority of my work day Please tick only those that are relevant to you.
Do you have a family history of genetic disorders? *	If none please write NA.
Please list any childhood illnesses *	If none please write NA.
Please list any current medication *
Please list any current supplements *
Do you consume any of the following substances? *	Coffee Tea Alcohol Cigrarettes Other None of the above
Other:	Please confirm 'other'
Mobility *	Overall Mobility Rating 1 - lowest and 10 highest. Please note we are not wheelchair or motorised-scooter friendly at this stage. Please also note we are quite hilly and guests participate in walking and exercise each day.
Health *	Overall Health Rating 1 - lowest and 10 - highest. Please note that we are not a medical facility and are an hour from the nearest hospital. If you are in serious need of medical attention, please consult your medical professional.
Do you have a belief system? *	If none please write NA.
Comments or Special Needs *
Typical breakfast *	List the foods you eat for breakfast.
Typical lunch *	List the foods you eat for lunch.
Typical dinner *	List the foods you eat for dinner.
Do you eat Cultured foods? *	Examples are Sauerkraut, Miso, Natural Yogurt, Kefir, Kombucha, kimchi, Natto, Tempeh and Sourdough
Snacks *	List the snacks you have throughout the day.

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9 Dietary Requirements

Allergies	Please list all (and ONLY) foods you are allergic to. Any personal preferences are to be added to 'Dietary Requirements'.
Diabetic
Sugar Free	Please tick if you are on a sugar free diet. Please tick also if you have cancer, thrush or candida.
Lentils/legumes	Please advise if you eat lentils and/or legumes.
Dietary Requirements	Please add any personal preferences or anything else you think we should know.

10 Retreat Information

1st Treatment *	Please choose 1st included treatment. See website for treatment explanations. For guests completing 15 day program you can include your 2 remaining treatments in 'additional treatments'.
2nd Treatment *	Please choose 1st included treatment. See website for treatment explanations. For guests completing 15 day program you can include your 2 remaining treatments in 'additional treatments'.
Additional Treatments	Alkaline Wrap Alkaline Wrap x5 Beautiful Eyes Package Coffee & Chocolate Detox Scrub & Body Wrap Deluxe Manicure Deluxe Pedicure Ear Candling Exfoliating Feet and Face Treatment Full Body Organic Sugar Exfoliation Head Massage Hot Stone Massage Hyperbaric Therapy Hyperbaric Therapy x5 Lymphatic Massage Misty Signature Facial Organic Full Body Wrap Organic Coconut & Honey Facial Remedial Massage Sitz Bath Sitz Bath x5 Sitz Bath x10 Swedish Massage Waxing Wood Therapy Massage Wood Therapy Massage x3 Please tick additional treatments desired. See website for explanations and pricing.
Bathrobe *	XS S M L XL Please choose a size. Please note bathrobes are for use at the retreat only and not to be taken home. Sizes over XL for your comfort please bring your own robe.
Email newsletter	Please send me the email newsletter
Terms and Conditions *	I accept the terms and conditions.All deposits are non-refundable. By request, funds can be transferred to a future program dependent on availability.

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11 Payment

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Deposit	$0

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	Your registration will be complete once we receive your payment. Please send your funds to: Misty Mountain Lifestyle Retreat BSB: 082 570 AC: 90019 6598 Reference: Surname SWIFT CODE (International Guests): NATAAU3303M Click on the button below and these instructions will be repeated on the next page.

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	By submitting payment, you authorise Misty Mountain Lifestyle Retreat to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Misty Mountain Lifestyle Retreat's agreement with you.

1 Welcome

2 Choose Dates

3 Choose Room

Select an option*

Lodge Rooms - Standard

Lodge Rooms - Deluxe

Hilltop Room - Deluxe

Hilltop Room - Twin

Hilltop Rooms - Standard

Ensuite Room

Family Units

4 People in your group

5 Book Shuttle

6 Personal Information

7 Arrival Details

8 Health Information

9 Dietary Requirements

10 Retreat Information

11 Payment