Discovery Call Intake Form
Thanks for your interest in working together. I am passionate about helping folks like you develop more skills for loving.  ❤️

Please take a moment to fill out this form so that our time together can be even more useful for both of us. 

If you haven't already scheduled a time for us to meet, please do so here.

I do require that this form be completed before we meet. Thanks for understanding. 
Sign in to Google to save your progress. Learn more
Email *
Your Name *
How did you hear about me? (The more specific you can be here, the better - if you found me on a website, please let me know which one... Fetlife? Cuddlist? Google search?)
What inspired you to reach out to me? *
When I work with people one on one, I use the boundaries of the Somatica method... this means that clothes stay on, there is no kissing on the lips and no genital touch. Are you willing to whole heartedly honor these boundaries? *
If you are interested in learning more about my story, here's a blog post that might be useful. 

Is there anything about your situation that you would like me to know before we meet?
If you're not already on my mailing list, would you like to be?
Clear selection
Are you interested in online sessions or in-person sessions, or a mixture of both? I conduct in-person sessions in Stanton, KY or at Centered in Lexington, KY. 
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms