Paradise at Harmony 
Dr. Juliana Dahl

Questionnaire

I am a Certified Tantra Educator. I teach Tantra Yogic Practices. I do not diagnose, evaluate or do therapy.

Please fill this out and email to drjdahl@gmail.com
Thank you ,
Dr. Juliana Dahl

Background Questionnaire
Name:
Phone number
Date

1.Tell me about your family of origin: Include birth order, siblings, relationship with siblings and parents. Was there emotional and physical closeness expressed between family members? Specifically include attitudes taught and conveyed about sexuality?

2. Give thorough description of your relationship history. Include length, how they began and ended and what was the main dynamic of each significant relationship. Describe cultural, ethnic and religious background and how any of these areas influences the formation of your ideas beliefs and values around sexuality?

3. Describe your sexual history from childhood to current time.

4. Give history of what you are interested is working with me in these sessions. In other words what is your intention?

5. Give medical history including any medications you are taking now?

Upcoming events

For Information or Appointments 
Phone: 303 931 9143 

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Sacred Sexuality
Paradise at Harmony, LLC
 

Aspen and Boulder, CO

303 931 9143
drjdahl@gmail.com