Intake Form

Thank you for your desire to heal and grow into your most full self.

Here are a few things I would like to know about you before we share time together,

Please answer wholeheartedly. All answers are kept confidential.

NOTE: Because you will NOT be able to save your answers once you begin, I suggest that you read through this form once, then pre-write your answers, and then copy/paste them into the form at once.

Name

First Name

Last Name

Age

Occupation

Date

Email Address

Please look for an emailed response to your intake form from me within 2-3 business days of submission!

Phone

(###)

###

####

Voicemail (Y/N)?

1. What inspired you to find me?

2. How did you find my site?

3. What do you most desire to experience in our time together?

4. What is currently most alive in you (your personal growth edge) when it comes to integrating your pleasure body, intimacy, relationships, heart and spirit? ie: places where you can't seem to break out of a pattern of behavior, belief or experience.

5. What does Intimacy mean to you? What does it make you feel in your body?

6. Have you experienced a session of this nature before? How was it for you? Is there something that you would like to experience with me that was missing for you?

7. Are you in a romantic &/or sexual relationship of any kind? If so, does your partner/lover know about your interest in working with me? Please note that I place no judgment on this. However, my intention is to support you to bring what you learn back into your life so that it serves the long-term well-being of your relationship. I also enjoy working with couples. If it would serve you &/or your partner to work with me in this way, please let me know.

8. Is there anything you would like me to be aware of around your physical or mental health (allergies, disabilities, etc?)

9. Is there anything else that you’d like to add?

Please read my Requests From You, listed below, and let me know if you are a "Hell Yes"

What I Request From You:

Respect of Boundaries Established Within Each Session
A Desire to Nurture Heart Connection
Willingness to Grow and Change
Eye Contact
Vulnerability
Honesty

What I Do Not Want In My Sessions:

Being touched without consent
Looking for a quick fix
Expectation of a performance

Please note that I reserve the right to end a session early if my boundaries are not respected.

Can you meet the above boundaries with a "Hell Yes"? Are there any that do not resonate well with you?

Thank you for your sharing

I look forward to guiding and supporting you on this soul journey