Alchemy of Love Enrollment Form

Alchemy of Love Enrollment Form

3 Month Embodied Relationship Deep Dive
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
What is your profession?*
Email*
example@example.com
Where are you located?*
Have you worked with Alexandra or Eli in the past? If so, where? Or, how did you hear about this program/find out about us? If via referral please let us know from who.*
Have you had any experience in polarity work or sacred intimacy containers? If so please tell us about it.*
Are you currently in a romantic partnership or longing to be in one? Please share a little about your present situation.*
What are three capacities, relationships, or areas of life you'd most like to shift or bring change to as a result of participating in this program?*
What's been the last significant and/or impactful experience that you've had in relationship, your marriage or in dating?*
What are your strengths and weaknesses when it comes to your practice and relationship? *
What's the most common thing you've heard as feedback from your partner, past or current, positive or negative? *
Do you have any physical, mental, or emotional challenges or trauma that might prevent you from participating fully in the program? Please feel free to share more details if that serves. All answers are held in confidentiality. *
What would need to happen for you to feel that Alchemy of Love was a success for you?*
If your partner will be joining, please let us know their first and last name.
Please upload a recent photo of yourself, so we can get to know you.*

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