Sacred Sexuality Retreat for Couples

Name

First NameLast Name

E-mail

Phone Number

Area CodePhone Number

Birthday

Location

The following information is to help both of us decide if this retreat is a good fit for you. It will also help me develop a retreat specific to YOUR needs and goals. Please be as a thorough and thoughtful as you can with your answers.

All your answers are strictly confidential and will not be shared with ANYONE.

AND please do NOT share your answers with your partner until you have both already submitted this form.

What are your relationship/sexual goals?

What other types of programs and practices have you explored to improve your relationship and/or sexual practice?

What are you CURRENTLY doing towards these goals?

What do you feel is keeping you from having what you want?

Please describe your relationship with your parents or other influential figures in your childhood.

Besides your partner, what are the significant relationships currently in your life?

Give a brief description of your spiritual beliefs and practices.

Please describe the sexual education and messages you received about sexuality while growing up.

Please describe any key sexual experiences, and how you feel those experiences affected you.

Please describe a peak erotic experience.

Wonderful or difficult things from my sexual/sensual HISTORY I want you to know are:

Wonderful or difficult things about my CURRENT sexuality/sensuality I want you to know are:

What is your masturbation practice like?

Please briefly describe any traumas (sexual or otherwise) you have experienced in your life.

What fears do you have surrounding this retreat and your goals?

Are you ready to commit to learning and growing through this retreat? Why or why not?

What questions do you have for me?

What are the best days and times for a phone call to discuss your answers and goals?