SACRED CEREMONY FOR COUPLES Questionnaire Form
Thank you for taking the time to answer these questions.
Name
First Name
Last Name
1. What are your personal intentions and goals for participating in this Sacred Medicine Ceremony for Couples?
*
2. Are you fully committed to participating in the entire ceremony, regardless of the challenges that may arise?
*
Yes
No
3. Are you willing to listen to each other's perspectives with the intention of fully understanding your partner's views, emotions, expressions, and desires?
*
Yes
No
4. Are you willing to speak your truth, express your emotions, perceptions, and desires for this relationship and for yourself?
*
Yes
No
5. Are you fully aware of the depth and intensity of the work you are about to undertake in this ceremony?
*
Yes
No
6. Have you discussed and agreed upon the importance of mutual respect, openness, and vulnerability during the ceremony?
*
Yes
No
We have not discussed or agreed but are willing to be in ceremony together to enhance our relationship and create a more harmonious connection.
7. Are you emotionally ready to confront any unresolved issues or past traumas that may surface during the ceremony?
*
Yes
No
I am not sure if I am emotionally ready to confront, but I am open to the opportunity to grow inward and with my partner.
8. Are you committed to using the insights gained from the ceremony to heal, enhance, and improve your relationship?
*
Yes
No
9. How do you plan to support each other emotionally throughout the ceremony and beyond?
*
I will be open to listen with the intention of understanding my partners perceptions, view and desires
I am going to pay attention to my own words, body language, and attitudes that may have a negative imprint and correct my reactions
I will do my sincere very best to be part of the solution and not the problem.
All of the above!
Other
10. What particular aspect(s) of yourself you think need attention?
*
11. What do you think makes a good relationship?
*
Please Select
True Connection
Healthy Communication
Sex, intimacy
Financial stability and agreements
All of the above
Other
12. How easy it is to maintain harmony in your home?
*
Please Select
Very easy
Somewhat easy
Easy
Somewhat difficult
Very difficult
13. How often do you talk about the importance of the harmony and wellbeing of your relationship?
*
Please Select
Daily
Once a week
Twice a week
Once a month
Twice a month
Once a year
Never
14. What do you admire most about your relationship?
*
15. Please rank what you consider is important to you in your relationship?
Rows
1 - Not Important
2 -little important
3 - Maybe
4 - Important
5 - Very Important
Deep Connection (Sex, Intimacy)
Security (feeling safe)
Fun time together alone
Responsibilities shared
Harmony in the home
My Partners Happiness!
Financial stability
Loyalty
Understanding
Space to be myself without judgement
Respect of point of views and disagreements
Spiritual Connection together and individually
Assigning shared tasks to keep the home clean and stable
Signature
Date
-
Month
-
Day
Year
Date
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