Name of the workshop/course you will be attending
Living Tantra 1
Touching The Love Within You
Finding The King Within You
Awakening The Power Within You
Integrating The Fire Within You
Embracing The Tantric Shadow
Advanced Sexual Empowerment
Date of birth
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Gender
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Sex at birth
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Have you completed a confidential questionnaire for a residential workshop you have attended with us in the past 12 months
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Occupation
Do you have any physical injuries or limitations?
Is a doctor treating you? If yes, please list conditions and treatments?
Do you take any prescribed medication?
If so, please list and state what it is for
If you use recreational drugs or alcohol please state drug, frequency and amount per week
How is your current lifestyle – including exercise, diet, sleep, self-care
Do you have a spiritual practice or belief?
What is your relationship status?
How would you describe your sexual orientation?
Do you have children?
If so, please give age(s)
What are your addictions/compulsive behaviours?
Please briefly describe your family of origin & where you grew up
(Please include the relative ages of any siblings)
What major relationship issues have you experienced?
Have you ever been in therapy? If yes, please describe
Have you ever received outpatient or inpatient care for mental health issues, or been prescribed medication for an emotional issue? If yes please give details
Do you have any history as the victim or perpetrator of violence, or the crossing of personal boundaries? If yes, please explain.
Have you ever been suicidal? If yes, please explain.
Have you ever experienced flashbacks or extreme fear about physical touch? Do you have any memories of physical, sexual, emotional or ritual abuse? If yes, please explain.
What have been your addictions?
What workshops or retreats have you attended previously?
What brings you to this course, what would you like to get out of it?
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If you got what you wanted, how might this affect your life?
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Can you think of any ways in which you might unconsciously sabotage yourself during the course?
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Is there anything else we should know or you would like us to know, or it is important that we know?
For the benefit of myself and other participants, I am willing to switch off my phone and other electronic devices, and to suspend contact with people outside of the workshop for the duration of the workshop?
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I understand that I will need to be at all the sessions during the workshop, and that if I miss sessions or try to join the workshop late I may not be able to attend.
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I understand that this workshop is not designed for the rehabilitation or treatment of PSTD, complex PTSD or developmental trauma.
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(If you have suffered from trauma, PTSD, or any other mental health condition, it is essential that you give details on the form above. Moreover, if you have concerns about whether the workshop is suitable for you due to these conditions it is essential that you discuss this with Ed, and seek the advice of a qualified mental health professional.)
Though there may be therapeutic benefits, I understand that this workshop is not a substitute for psychotherapy and that the facilitators are not psychotherapists.
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If you have questions or are not able make any of these agreements please explain below;
