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Couple's Medicine Retreat

Athera Sacred Arts

This retreat is a curated, intimate experience.
Each application is reviewed with care to ensure alignment, safety, and readiness for both partners.

If your application is aligned, the next step will be a private consultation call to explore your intentions, answer questions, and ensure this retreat is the right fit for both partners.

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Email *

Partner 1 Full Name:
Partner 2 Full Name:

Email Address (Primary Contact):
Phone Number:

City + State of Residence:

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Relationship Status:
( ) Married
( ) Long-term partnership
( ) Engaged
( ) Other: _______

How long have you been together?

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1. What is currently present in your relationship that is calling you into this work?

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2. What do you feel is the greatest strength within your relationship?
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3. What feels most challenging or tender right now?

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4. Have you experienced any major transitions recently?
(e.g. birth, loss, infidelity, relocation, career changes, etc.)
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5. What are your intentions for this retreat as a couple?
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6. What is each partner personally desiring to explore or move through?
(Please answer for both individuals)
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7. What would “success” or alignment look like for you after this experience?
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8. Have either of you participated in:

( ) Therapy / counseling
( ) Somatic healing work
( ) Breathwork
( ) Ceremonial or spiritual practices
( ) Plant or indigenous medicine work
( ) None of the above
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9. Please briefly describe your experience with any of the above (if applicable):
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10. Are both partners equally willing and open to participating in this retreat?
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11. Is there currently any active abuse (physical, emotional, or psychological) in the relationship?  please explain
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12. Are either of you currently experiencing severe mental health challenges that may require additional support?
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If yes to any of the above, please share what support systems are currently in place:

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13. Do either of you have any medical conditions we should be aware of? Please describe.

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14. Are either of you currently taking medications? please share
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15. Do you have any allergies or sensitivities? please share 

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16. This retreat includes emotional, physical, and relational exploration. Are you both willing to: (please type yes or no with your name)

( ) Be honest and open
( ) Take personal responsibility for your experience
( ) Engage in guided practices and ceremony
( ) Respect boundaries and the container
( ) Communicate if something feels unsafe or overwhelming
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17. Are you prepared to invest financially, emotionally, spiritually, energetically in a holistic healing and awakening experience inclusive and not limited to energy work, healing touch, somatic experiencing? 

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18. Why are you choosing this work now?
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19. Is there anything else you feel is important for us to know as we consider your application?
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20. What does your relationship feel like when it is in its most aligned, connected state?

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21. Payment plan are available with a $3-500 deposit per person. Please choose what is in alignment for you. All payment plans will incur interest unless you pay in full at time of registration. Final payment is due no later than August 1st. *
Consent Understanding Signature of both parties:

This work is sacred, relational, and deeply personal.

We honor that stepping into this space requires courage, willingness, and trust.


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