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 sacredsexy@aol.com or fax to
303 593 2995 .
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: 303 593 2995
cell: 303 931 9143 

Directions

| Tantra for Couples | Tantra for Women | Tantra for Men |
| Dr. Juliana Dahl | Tantra in Paradise | Phone Consultations |
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Sacred Sexuality
Paradise at Harmony, LLC
1455 Gillaspie Dr.
Boulder, CO 80305
Phone: 303 593 2995 or 303 593 2996
cell: 303 931 9143
info@sacredsexyes.com

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