The Eastern Orthodox Church recognizes seven holy Mysteries (sacraments): Baptism, Chrismation, Eucharist, Confession, Holy Orders, Matrimony, and Holy Unction (Anointing of the Sick). Following ancient practice, the three Mysteries of initiation are administered together: baptism (by triple immersion), followed immediately by Chrismation (anointing with myrrh), and then Holy Communion—even for infants. This unified initiation is the ancient norm, still preserved in Orthodoxy in contrast to the Western practice of separating Confirmation and First Communion by years.

The Divine Liturgy of St. John Chrysostom (celebrated most Sundays) and the Divine Liturgy of St. Basil the Great (ten times per year) are the central acts of Orthodox worship. The transformation of the Eucharistic gifts is affirmed (Orthodox theology uses the term 'metabole'—transformation—rather than 'transubstantiation'), effected by the epiclesis (invocation of the Holy Spirit). The Real Presence of Christ in the Eucharist is firmly held. The liturgical richness of Orthodox worship—icons, incense, chanting, vestments, and the iconostasis—reflects a fully sacramental understanding of materiality as capable of bearing the divine.