Appointment Form

PREPARATION

My sessions are to enlighten, awaken and empower your life and relationships. Please come with an open mind so that the session is flowing for you. Cultivating a mindset of healing and growing is important therefore scheduled appointments are recommended.

I need some information from you so that I can get to know you better and customize your session to meet your goals. Couples and singles need to fill out the form.

Please wear loose clothing, no colognes, deodorants or perfumes. No alcohol and do not eat two hours prior to the session.

Your Name (required)

Your Email (required)

Age:

Birthday:

Your location:

Phone:

Best time to reach you:

What are you interested in? (select multiple options by holding down Ctrl on your keyboard.)

Gender:
 Male Female

Marital status:

Please tell me about your prior background in Tantra, yoga, psychotherapy and spiritual growth development:

Please tell me about yourself, what you do for a living (your career), what you do for fun, what your diet is like, and what your physical exercise is like:

Please tell me if you have any addictions and if you're on any medication:

Have you ever attended tantra workshops or experienced a tantra session with anyone else? Have you ever received body oriented or traditional psychotherapy sessions before and with whom?:

What are your goals for the session? What do you want to achieve and learn? What do you want to improve about yourself?:

Tell me about any sexual and intimacy challenges you may be dealing with or addictions or abusive experiences? Tell me about your relationship life?:

How did you hear about me?:

Desired date for appointment:

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