Tantra Wellness Session Intake
Please allow yourself ample time to fill out this form, it helps me understand your intentions, boundaries, and needs so I can hold a safe, respectful and aligned container for our work together. Please answer honestly, all information is kept confidential. I look forward to embarking on this journey with you!
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Email *
Name: *
Date of Birth: *
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Age: *
Weight/ Height: *
Phone number: *
Location (City & State): *
How did you hear about my services?, Did anyone refer you?  *
Share with me your relationship status, are you Monogamous? Polyamorous? Anything specific you’d like to highlight about your current romantic dynamic? *
What best describes what you’re experiencing  *
Required
What are your spiritual beliefs? What is your relationship to God? (Please elaborate) *
Were you raised religious?  How do you feel about religion?  Do you have trauma around religion?   *
Do you have any current injuries, chronic pain, or physical conditions that I should be aware of? *
What things do you for self care, self growth and healing? *
Do you experience anxiety, panic, dissociation, or emotional overwhelm or disconnection? *
Do you have any daily practice that connects you daily to your mind body soul?  (Meditation, Exercise, Breathing, Yoga, Walks) *
Briefly describe what does your morning routine consist of? *
Have you experienced trauma (emotional, physical, sexual, or relational) that may be relevant to this work? *
Are there any triggers I should be aware of? *
Are you aware of your attachment style in relationships? *
Required
Do you know about chakras?  What is your knowledge on these? (advanced- very little) *
What do you do for work? How much of your time do you devote during the week to your job and are you satisfied?  *
Do you have a sense of purpose in life?  *
When you feel overwhelmed, what helps you feel safe or grounded? *
What is calling you into this work at this time? *
What would you love to receive or experience? *
What does "feeling safe in your body" mean to you right now?  *
Have you done any work around regulating your nervous system?  Are you aware of what this is or what it looks like? (fight, flight, or freeze) *
FATHER/ FATHER FIGURE: Please explain the relationship you had with your father growing up & how it is now.  Share qualities and traits of your father, both good and bad.  Share ways they have been hurtful and helpful. *
MOTHER/ MOTHER FIGURE: Please explain the relationship you had with your mother growing up & how it is now.  Share qualities and traits of your mother, both good and bad.  Share ways they have been hurtful and helpful.
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PARTNER/ SPOUSE: Please explain your relationship with your partner currently?  Give me 3-5 things you're working through or wanting help on in partnerships?

If you're not in partnership, where are you with how you feel about relationships?
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How comfortable are you currently when it comes to boundaries & and expressing/ vocalizing your needs *
Have you ever been in a relationship that was emotionally and or physically abusive? *
Do you know why you are on this planet?  Have you found your purpose/ passion? *
Completely Lost
Yes! Absolutely
What are your passions?  *
Do you know the right next steps you need to take to achieve your dreams? *
Completely Lost
Yes! Absolutely
Do you feel abundant? *
No, not at all
Yes! Absolutely
On a scale of 1-10,  how well do you accept your body as it is?  Feel free to add details about your body image. *
Do you experience anxiety on a regular basis? *
No, not at all
Yes, absolutely!
Do you feel grounded and at peace most of the time? *
No, not at all
Yes, absolutely
Have you experienced a tantric massage before, and if so what was your experience? *
What are your goals and intentions for wanting to embark on this healing journey (as they will both guide this work)?  I am here to support your deepest and highest intentions for yourself.  *
Please include a link to your business website, LinkedIn, Facebook, or Instagram to verify your identity.  Please understand your responsiveness will remain private and discreet. 
 
**IF YOU DO NOT LEAVE A LINK OR A REFERENCE, I WILL NOT RESPOND TO YOUR SUBMISSION.  This is for my safety and discernment.
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By checking the box below, you understand that I only meet with honest and open individuals with a genuine interest in pursuing a more soulful experience.  I ensure that any information you share, including our sessions, is sacred and therefore confidential.  

There is a 50% deposit to hold the scheduled booking after our initial video call, this is not refundable.

If there is a cancellation within 48 hours of the scheduled booking,  there is a $100 reschedule fee, and the other half of the total is owed. 

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Required
Your safety is my priority.  If you are pregnant, had any surgeries, have heart conditions, any other diseases, please speak with your physician.

**You are responsible for asking your physician based on your unique situation first to be sure It’s safe for you to receive sound healings with crystal bowls, tuning forks, & gongs.  
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