H Opp Weekend interest list

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The Opportunity Weekend is an experience (not a class or a lecture). You will be interacting directly with me, my amazing team and other participants. We will be talking, playing, sharing, learning and practicing some amazing new skills together. You are going to experience a space that is 100% dedicated to your growth and your happiness.

This questionnaire gives us an opportunity to get to know you before we decide to work together. It also gives you an opportunity to make sure this is really something you want and are ready for. There are no right or wrong answers. Participants will be contacted on a first-come, first-served basis.

I look forward to going on this journey with you.

In support,
Adrial

Email *

Name (First, Last) *

(Your privacy of utmost importance. All information will be kept safe.)

Email address *

(To have a followup conversation about the weekend.)

Gender *

Female

Male

Age *

Where do you live? *

(City, state, country)

How long have you known about having H? *

What are your biggest challenges in living with H? How do you think H may be holding you back from living the life you want? *

What is most bothering you about having H? *

(Choose all that apply to you)

[ A ] "I'm scared/sad/upset about it; I think about it a lot and it can be overwhelming. It has really been a huge blow to my self-esteem. I feel like my life has taken a turn for the worse. I want to feel better about myself and my future.”

[ B ] "I'm dating and feel like I just can’t be myself. I keep worrying and thinking 'if you only knew ...’ I’m worried I’ll be segregated to H-only dating. I want to enjoy dating again like it was before.”

[ C ] “I’m scared about disclosing to potential partners. I know I’d feel horrible if I didn’t disclose, but I feel like every time I have “the talk” I’m just going to chase them away. I just want to disclose in a way that brings us closer.”

[ D ] "Even if a partner does accept the potential risk, it's hard to imagine getting into a relationship without being paranoid about spreading it. I really want to be safe and protect my partner, but wonder if I’ll ever be able to truly enjoy sex without the fear/paranoia. I want sex to be exciting and connecting.”

[ E ] ALL OF THE ABOVE

Other:

Required

Which of these sentences best describes how you relate to telling people about H? *

I’m terrified and can’t imagine how to handle it.

It’s scary, but I’m willing to do it when I have to.

It can be vulnerable, but I’m okay sharing this when the time is right.

It’s really no big deal. I feel good about myself and don’t mind talking about this.

Which best describes your current relationship status? *

I'm single

I'm dating

I'm in a relationship

Other:

What are your top 3 goals for coming to the H Opportunity weekend? *

I want to learn about how to manage sex and intimacy with herpes.

I want to clear shame.

I want to enjoy dating and relationships again.

I want to get better at talking about herpes.

I want to forgive myself.

I want to create connections and friendships with other people who have herpes.

Other:

Required

What kind of support do you currently have for dealing with herpes as part of your life? *

(for example: friends, family, support group, personal coach, therapist or counselor?)

Have you ever done a personal growth workshop or seminar? *

If yes, please explain your experience of it; if no, please explain your thoughts on coming to this one.

It takes courage to step outside of your comfort zone, commit to change and come to a weekend like this. What has you inspired to come to the course? What are you wanting to get out of it? *

How did you hear about the H Opportunity and this course? *

(Search engine, another website, youtube, etc.)

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