Couple’s Questionnaire – The Ecstatic Body

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Conscious Loving
Ecstatic Soul Retreat
Massage
- Women
- Men
Breathwork
- Workshops
- Private sessions
Shop
About
Blog
Contact us
Login

“Begin your intimacy journey here!”

The Ecstatic Body!

Heather Rhea Dawn

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Couples Questionnaire

Your Divine Union Transformation starts now…
After you respond to the following questions, with as much information as you would like to share, we’ll discuss customizing your session to assist you in your journey to Tantric Bliss. Everything you share with me is confidential. Naturally the more authentically you communicate your needs and interests, the better I will be able to assist you. I value and respect your honesty. I look forward to serving you. Please both of you take the time to answer each question…either answer them on the same page or separately. Thanks and blessings!

Today’s Date

Partner 1
First Name

.
Last Name

Email Address

Phone number

Profession

Age

Partner 2
First Name

.
Last Name

Email Address

Phone number

Profession

Age

What are your profession?

How did you hear about me?

What is your Tantra Experience? Please describe…

What desired outcome are you hoping to achieve in your session?

What do you know of Tantra? And what brought you to wanting sessions?

What do you specifically want to learn or heal or experience from our work together?

What recurring issues and challenges are coming up in your life that you would like to address?

Describe your physical and sexual health (STDs)?

Have you ever been diagnosed with a life threatening illness?

Have you had any traumatic surgeries (or births if you a female)?

Are you taking any medications that affect your sexual libido?

Answer from 1-10 (10 being empowered) for Her Do you feel empowered in your body? In your life? In your relationship? Explain answers please:

How do you feel about your body?

Have you ever been sexually, emotionally, or physically abused (please describe)?

Briefly describe your relationship with your family? (EX: Healthy or Challenging relationships with parents/siblings etc.)

How long have you been in relationship?

If so, what is your relationship dynamics?

Happy and Harmonic Content Challenged In Trouble

How is your communication skills with each other?

Would you like to learn how to communicate better?

How are you at expressing your feelings with each other?

Would you like to learn how to do conscious clearings around triggers with each other?

How your sex life is?

Great Good Ok No longer have sex Complicated

Please describe what areas you need support in with your sex life? And what it is like now?

How often do you make love?

Are you getting enough touch in your relationship? And the kind of touch you want/need?

Are you wanting something you are not asking for in your relationship or with touch? (monogamy, poly, kink, energetic sex, a type of touch…anything)

How are you at receiving pleasure?

How are you at giving pleasure?

Is there any kind of massage you want to learn?

Tantric Massage BodyDance Massage (Body-to-body massage) Sacred Spot Massage (for healing and pleasure) Lingam Massage (for healing and pleasure) Therapeutic Massage

Do you want to learn more techniques on how to pleasure your partner sexually? Sensually?

Anything else I need to know about your current or past relationship with women/men?

Do you have children?

If so, please list their names, ages, and describe your relationship with them.

What is your relationship to pleasure? 1-10 (10 being very comfortable) Please explain:

Do you have experience with meditation?

Have you ever done yoga?

What is your religious background or spiritual beliefs?

Click which type of orgasms you have experienced (please check all that apply)
female:

Full Body Multiple Anal Blended Ejaculation/Amrita Clitoral

Male:

Full Body Multiple Prostate Non-ejaculatory Anal

Have you ever experienced male "Sacred Spot Massage" or "G-spot Massage"?

Yes No

Are you looking for (check one or all that apply with an X. P1 is partner 1, P2 is partner 2)

P1 P2

Sexual Healing How to be empowered in your touch-giving, receiving, allowing & taking pleasure Ask for what you want Better communication skills Open up Pleasure in Gspot (for women) Ejaculation Choice (for men) Erectile Dysfunction Support (for men) Increase Overall Pleasure in Your Body How to pleasure your partner Self Love- How would you rate your self love 1-10 (10 being in love with you) Self Pleasuring Tools Learning about Meditation How to open your energy body Learn how to run energy with another Learning Yoga to Open the Body

When would you like to meet for our first session?

Is there anything important about you I need to know that was not asked?

A few things you need to know about me and this work…I am a Certified Tantra Educator/Kundalini Yoga instructor, Bodyworker and most of all a Healer, this if first and foremost. This work is to empower people, to support healing and opening, create healthy relationship skills, have a better love life & to love themselves more deeply. I work with breath work, meditation, yoga, trauma release work, movement, massage, pressure points on the body, consent work and many other supportive tools to open the body, energy, release trauma and to increase pleasure and connection with spirit in all of it. It is a journey of coming back home to yourself so you can have a healthy relationship with you and your beloved.

Things you need to know what isn’t in this work:
I do not have sex with my clients.
This is not about release for men…it’s about deepening pleasure and consciousness.

Thank you!
See you soon.
Bliss, Heather

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