Survey 01

Which of the following best describes your current relationship status?
How long have you been in your current relationship?
What year were you born? (enter 4-digit birth year; for example, 1976)

What zip code do you live in? (enter 5-digit ZIP code; for example, 00544 or 94305)

What is your (individual) approximate gross yearly income? (e.g. $40,000)

How often do you exercise?
Rate your day-to-day stress on a scale from low (1) to high (5)
(1 least stressed, 5 most stressed)


Do you and your partner currently, or have you in the past, see a therapist or counselor?
Do you currently take any medication prescribed by a therapist?
If YES, what medication? (List medication and indicate if current or past prescription)

What spiritual practice do you have? Or what religious affiliation do you belong to?
How would you describe the communication between you and your partner? (your typical experience)


What challenges are you experiencing in your relationship? (check all that apply)


What are your top three goals for your relationship that would make it better right now? (what's most important right now?)

Describe the three most important qualities a good relationship should have: (What does happily ever-after look like to you?)

How often do you have sexual intercourse with your partner?


When you have sex with your partner how would characterize it, usually?
Describe your relationship as it is right now. If it feels like it's shifting, describe where you feel it is going.
When you hear the phrase, “sacred sexuality” or “erotic spirituality” what words or images come to your mind? What meaning do you attach to the phrase?
If you knew there is a program that would enable you to transform your relationship with your partner and experience a deeper, more soulful connection together, would you consider it?
What questions would you need answered to make your decision?
If you could choose between a home study program (virtual retreat) that you could do from home with your partner or a retreat that would involve travel time, which would you choose and why?
What would you say is the ideal time (month) for a retreat or romantic getaway?


Is it OK to quote you without attribution (not use your name)?



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Sunyata Satchitananda

Counselor, Coach, Certified Sexual Healer at Sunyata Satchitananda
Sunyata is a Spiritual Counselor, Certified Tantric Healer and Author of "Safe Sexual Healing: a Guidebook for Healers and Clients." Ordained Minister (1980), Certified Tantric Healer (2007), Reiki Master (2009). Sunyata specializes in helping men and women achieve deep transformation, spiritual growth, sacred sexuality, heal from sexual abuse and emotional trauma, and develop a greater, deeper intimacy and connection with their partner.
Sunyata Satchitananda

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