Keys To A New Life Questionnaire Form

Select an event...THE ESSENCE OF FLOWERING7 DAY THE ALCHEMY OF TANTRATRAUMA HEALING RETREATATISHA’s LAMP OF THE PATH FOR NIRVANATHE LANGUAGE OF THE BODYTHE BARDO RETREATOSHO Vipassana Retreat at Ozen, MexicoOSHO Evening MeditationKirtan – Evening MeditationWealth Beyond MoneyFrom Depression to ExpressionLove in ActionAn intensive flushingIt’s the Teens’ Summer Training!Individual SessionsLiving in our CommunityEmotional Awareness & Intelligence

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Dedicate some time to answer these questions, as it will help you prepare for the process. Your answers will be kept confidential. Please do not show this questionnaire to anyone, as it is part of the confidentiality of the process. For questions that do not apply, please state 'does not apply'.

List your main reasons for doing Keys To A New Life. *

List five "positive" qualities that you have: *

List five "negative" qualities that you have: *

Are you currently in a relationship? If you are, for how long? If you are not, how long since you have been in a relationship? *

Are you satisfied with your sexual life? If not, what is missing? *

Have you been physically, emotionally or sexually abused at any point in your life? If yes, please be specific. *

Briefly describe three of your most beautiful experiences and how they have shaped your life. What have you learned from them? *

Briefly describe three of your most painful experiences and how they have shaped your life. What have you learned from them? *

Describe the issue that has consistently caused the most pain or suffering throughout your life. *

What creates stress in your life and what is your primary response to stress? *

What supports relaxation in your life? *

What are you enthusiastic about in your life today? What are you proud of? What are you grateful for? *

Do you have any regular practice such as meditation, yoga, running, working out etc? *

Anything else you would like the process leaders to know about? *

Please provide us with an emergency name and contact number. Thank you. *

By my signature, I represent that all the answers to this questionnaire are true and correct.
I understand that any false statement is a ground without more for the termination of my participation in the program.

Please Note: As this form will only submit if all fields have been filled out, please make sure you have completed them all.
If a question does not apply, you can write "Does not apply".

Thank you!

The Path Retreats Team

Signature

(Please type your full name in the box): *