Private Cacao Ceremony Questionnaire

A warm welcome to you. You've just taken a courageous step by committing to put your To Do list aside and create this space for yourself (that’s no small feat in this go-go-go society!) As your guide during this mini ceremony, I want to design our time together to best serve you. Please take a moment to fill out the form below in preparation for our session.

xoxo,
Carrie

Please carve out a bit of space to respond thoughtfully and submit this form to me at least 24 hours before our ceremony.

*I recommend that you compose your answers in a separate online document or handwrite them and then input into this form. The website does not auto-save, and you could lose your work if you attempt to fill it out over time.

Name

First Name

Last Name

FAMILIARITY

Have you ever experienced ceremonial-grade cacao?

Yes

No

OVERALL GOALS

Do you have any general expectations for this ceremony? What would you like to come away with?

SELF-CARE

What does self-care mean to you? Do you find it challenging to make space for self-care? Why or why not?

CHILDHOOD HOBBIES

When you were a child, were there any activities that were so interesting to you that they could cause you to lose track of time (you had to be reminded to come home for dinner, go to bed etc.)? Please tell me about them.

CURRENT HOBBIES

Are there any activities in which you now participate (as an adult) that cause you to lose track of time? Please tell me about them.

CEREMONY DESIGN

Which of these options for our time together most appeal to you (can check more than one)?

Learning about ceremonial cacao origins

Learning about ceremonial cacao benefits

Guided meditation

Introspective journaling

Intro to the Mayan Cosmovision

Breathwork

Mind Body Coaching

WHAT ELSE?

Is there anything else you would like to share that can help me best serve you during our time together?

Private Cacao Ceremony Questionnaire

Avocado to Zen