Costa Rica
Couples Retreat 2024
Name (Partner 1)
First Name
Last Name
Name (Partner 2)
First Name
Last Name
Email (Partner 1)
example@example.com
Email (Partner 2)
example@example.com
Phone Number (Partner 1)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Partner 2)
Please enter a valid phone number.
Format: (000) 000-0000.
How long have you been together?
Less than 1 year
1-3 years
3-5 years
5-10 years
10+ years
What is your current relationship status?
Married
Engaged
Long-term partnership
Dating
Why are you interested in attending this retreat?(Please describe what you hope to gain from this experience as a couple.)
What are the strengths of your relationship?(Please highlight what you feel is working well in your relationship.)
What challenges are you currently facing in your relationship?(Please be specific about any areas where you feel there is room for growth or improvement.)
Have you attended any couples therapy, workshops, or retreats before?
Yes
No
If yes, briefly describe your experience.
What are your goals for this retreat?(Please describe what specific outcomes you would like to achieve during the retreat.)
Are both partners fully committed to participating in all retreat activities, including workshops, exercises, and group discussions?
Yes
No
How do you both typically handle conflict in your relationship?(Please describe your approach to resolving disagreements and conflicts.)
What do you enjoy doing together as a couple?(List some activities or hobbies you both enjoy.)
Do either of you have any health concerns or special needs that we should be aware of?
Yes
No
If yes, please describe:
How comfortable are you with being part of a small, intimate group setting?
Very comfortable
Somewhat comfortable
Not comfortable
Please elaborate if needed:
What do you expect from the other couples attending this retreat?(Describe any qualities or attitudes you think are important for the group dynamic.)
What are your intentions for your relationship post-retreat?(Describe how you plan to integrate what you learn during the retreat into your daily life.)
Are you open to sharing and receiving feedback in a group setting?
Yes
No
Please explain your response:
Do you have any dietary restrictions or preferences?(Please list any specific dietary needs.)
Is there anything else you would like us to know about you or your relationship?(Feel free to share any additional information that may help us understand you better.)
Submit
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