FAMILY SACRED CEREMONY Questionnaire Form

SACRED FAMILY CEREMONY Questionnaire Form

Thank you for taking the time to answer these questions.
Name

First NameLast Name
1. What are your personal intentions and goals for participating in this Sacred Family Medicine Ceremony?*
2. Are you fully committed to participating in the entire ceremony, regardless of the challenges that may arise?*

YesNo
3. Are you willing to listen to each member's perspectives with the intention of fully understanding their views, emotions, expressions, and desires?*

YesNo
4. Are you willing to speak your truth, express your emotions, perceptions, and desires for the wellbeing dynamics of the family and for yourself?*

YesNo
5. Are you fully aware of the depth and intensity of the work you are about to undertake in this ceremony?*

YesNo
6. Have you discussed with each member of your family and agreed upon the importance of mutual respect, openness, and vulnerability during the ceremony?*

YesNoWe have not discussed or agreed but we are all willing to be in ceremony together to enhance our family dynamic & create a more harmonious connection with each.
7. Are you emotionally ready to confront any unresolved issues or past traumas that may surface during the ceremony?*

YesNoI am not sure if I am emotionally ready to confront, but I am open to the opportunity to grow inward and with my family.
8. Are you committed to using the insights gained from the ceremony to heal, enhance, and improve your relationship with your family?*

YesNo
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 their perceptions, believes, views and desiresI am going to pay attention to my own words, body language, and attitudes that may have a negative imprint and correct my reactions towards each member of the familyI will do my sincere very best to be part of the solution and not the problem.All of the above!
10. How would you describe your family's current level of Good Vive Energy ?*

very lowneutrallVery high
11. What would you say are the family issues today?*

Lack of connection & understandingToxic environmentUnsafe home, no supportPast hurts and resentmentsMoney issuesOther
12. What is the family biggest strengths or values?*

Mutual understanding & respectLoving environmentSafe & supportive homeWe all ready and like to evolve from our own human limitationsOther
13. What are the changes you will like to see in your Family?*

More maturity and emotional intelligence in dealing with disagreementsFreedom to live life without shame, judgement, manipulation, or expectationsHarmony, peace and fun times togetherMutual respect and understandingOther

14. Please rank what you consider is important to you in your Family relationship?

	1 - Not Important	2 -little important	3 - Maybe	4 - Important	5 - Very Important
Deep healthy Connection (in Communication)
Security (feeling safe)
Harmony, peace & fun times together as a family
Responsibilities shared, everyone give & take
Healthy Emotional Expression
Financial stability
Being trusted & understood
Space to be myself without judgement
Spiritual Connection Family & individually
Felling of being heard & acknowledge
Feeling appreciated
Feeling accepted & loved

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SACRED FAMILY CEREMONY Questionnaire Form