Costa Rica Retreat Intake — The Remembering

We know these questions are personal and intense. Being on a retreat with other is so much about doing your own work first, in order to step into holding space for others.

These questions are designed to make you dig deep.

Remember this is totally anonymous and purely helps us align the right people together for this retreat.

Name *

First Name

Last Name

Email *

Phone

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What's your birthday?

Do you have any children? How many? How old?

If you have children... how were your births?

What's your relationship status?

Do you have a religious or belief system that guides you?

Are you good at creating boundaries?

Have you ever witnessed a birth besides your own? What was your experience?

Birth work is NOT a job... It is a calling! You will learn quickly that it becomes a lifestyle and everyone in your life has to be supportive of this new lifestyle. Honestly, do you feel like you have a support system intact for this? If yes, why? If no, what could you shift in your life to feel more supported?

Do you believe in women having full autonomy over their bodies? Meaning that they know their bodies better then anyone else…even healthcare providers and can make inherent decisions for themselves and their families?

Do you know the history of childbirth?

Are you willing to learn about traditional birth practices from other cultures?

Do you feel comfortable in a hospital setting?

Do you believe that modern Western medicine has made childbirth flawed?

What do you believe your "style" would be as a doula?

Do you have any fears about the doula training or birth work in general?

What are your intentions for this experience? What do you hope to receive?

Do you believe it is safe for women to have their babies at home?

I believe a woman in labor is:

A medical emergency

Best unobserved in her natural surroundings

Needs to be approached with reverence

Everyone should have free births

Do you have any physical limitations that we should know about?

I have an awesome romantic relationship and feel supported.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I have great friends and a great community

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I love my career, feel well supported & not burnt out

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I feel like I have a sense of purpose

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I feel like I have lots of joy and play in my life

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I feel abundant and don't fear my finances

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I feel supported from my relgion and spirtuality

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

In the past year i've:

Got Married

Changed work situations

Gotten divorced

Had reproductive difficulties

Gained a new family member

Had an illness of a child

Have a child with special needs

Had a change in custody of my kids

Have been working through sexual trauma

Have experienced domestic violence

Had the death of a close family member

Dealt with addiction

Dealt with a partner that has addiction issues

Cared for a sick family member

Cared for an aging parent

Any further details you want to share

Belief system disruptors i've had

Began or ended schooling

Stated a new career

Had a political or social awakening

Had a change in relgion or spirtuality

Had extended personal travel

Had a change in community service habits

Have experience a collective event (war, sickness..)

Any further details you want to share?

Body Disruptors i've had:

accident or personal injury

chronic illness

mental illness

personal addiction

recovery from addiction

weight issues or changes

changes in personal health habits

Any further details you want to share ?

What current challenges do you struggle with most in life?

If your current "life chapter" had a title, what would it be?

What were you like at 5 years old? 13 years old?

List 8-10 things that you are grateful for and bring you joy

What do people consistently come to you for?

If you had all the money, power or influence what would you dream about?

What do you want in life that you believe you're not currently getting?

What are you uniquely agitated or frustrated by in the world?

Do you have a prayer or meditation practice?

Thank you!

Stay in touch.

Questions?