Screening Questions for Participants
Hello, dear one. We are so glad you are here. Thank you for taking the time to fill out this brief questionnaire. Once we receive your information, will contact you to schedule a brief intake call. We really appreciate your candor and vulnerability. It helps us provide a positive experience for everyone and ensure that we are able to hold space with integrity. Your responses are absolutely confidential and will only be shared amongst the three facilitators. If you are uncomfortable filling out a form with this information, please email Lianne at
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Email *
Full Name *
Phone Number *
Please share a little bit about yourself (age, gender, orientation, relationship status, professional life, etc.) *This is an inclusive space! We ask for these personal details so that we know who is in attendance and can tailor the experience to best serve you. *
Why are you feeling called to this retreat? What are you hoping to get out of it? *
Have you ever attended a similarly themed workshop or retreat focusing on eroticism? If so, please share about this experience. What did it entail? How did you feel about the facilitation and space holding? How was the experience for you overall?
On a scale of 1 to 10, with 1 being "Not at all Edgy" and 10 being "Extremely Edgy", how edgy is a retreat of this nature for you? *
Do you currently own a yoni egg or crystal wand? *
Would you be interesting in purchasing one for this event?
What is your relationship with cannabis and other plant medicines?
You do not need to provide any details here, but we would like to be informed if you have a history of acute sexual trauma. Please be prepared to be asked this question on our call. You can decide how much you are comfortable sharing with us. We will share more about our approach to this work so that you can gauge whether or not it will be supportive for you. Healing sexual trauma is indeed a deep part of this work, but depending on the nature of your trauma, this may or may not be the right container for you. Please note that we are not psycho-therapists or trauma experts. We are facilitators and erotic activists. *
What is the earliest you could join us on Friday?
What is your preference for accommodation? (Tickets start at $555 and include individual consultations). *
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