Sacred Center Yoga - Intake & Waiver
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Yoga Therapy for Sexual Wellness & Somatic Sex Education
Yoga Therapy for Sexual Wellness is the process of empowering individuals to progress towards improved health and well being through the applications of the philosophy and practice of yoga. Sessions can include coaching in breath,
movement, body awareness, boundary-setting, communication, anatomy, sensate focus, massage, erotic trance and other body-based teaching about sexuality. Yoga Therapy for Sexual wellness is designed to nurture, deepen or awaken the sensual self.
Your intention(s) and goals will guide this work. I am here to support your deepest and highest intention(s) for yourself. Please consider and state your deepest intention(s) regarding general wellness, sexuality, spirituality and eros. In addition, please write down any specific goals that you would like to accomplish during our work together.
Tell me about your intimate relationships
General Health Questions
Would you like to explain any specific health problems or challenges in your life?
Tell me a little about your lifestyle? Diet? Exercise program? Do you smoke or drink?
How is your breathing?
How would you describe your energy levels?
How is your stress level?
How do you have fun in your life?
Do you have a spiritual practice or a sense of the sacred that is part of your life? What is the role of sexuality within this (if any)?
Sexual History & Information
(Please address only those questions that feel relevant. I assure professional confidentiality. If you want me to work together with your psychotherapist, medical doctor or other health practitioner, I will ask you to sign a release form.)
Difficult things from my sexual/sensual history I want you to know are:
Wonderful things from my sexual/sensual history I want you to know are:
Difficult things about my current sexuality/sensuality I want you to know are:
Wonderful things about my current sexuality/sensuality I want you to know are:
On a scale of 0-10, how well do accept your body as it is? (0 = No acceptance 5 = Moderately accepting 10 = I love and accept my body exactly as it is.) Add details about your body-image.
Tell me about your intimate relationship/s.
Scars from abdominal surgery, childbirth, trauma and circumcision can affect sexual function. Do you have any scars on your body that you might want to have worked on? If yes, please describe the scar and when it occurred.
Please add anything else you would like me to know about your sexual history or current desire patterns, including gender identity, sexual orientation(s), self-pleasuring practices, fantasies, use of pornography, or any other information that you feel may be relevant.
How may I serve you best?
Exploring who I am as an erotic being
Passionate Relationship, expanding possibilities for couples
Massage Lessons for Lovers, learning the arts of sacred touch
Learning the anatomy of arousal
Experiencing and learning Tantric techniques
Experiencing and learning Taoist Erotic Massage
Exploring the intersection of sex and spirit
Orgasmic birth coaching
Loss or lack of sexual desire – inside or outside of relationship
Healing female sexual dysfunction, erectile dysfunction, prematureejaculation, inhibited ejaculation
Reconnecting to sex after childbirth, menopause, or prostate surgery
Learning to experience and give a partner extended and multiple orgasms
Deciphering sexual identity
Chronic pelvic pain, vulvodynia, constrictions that inhibit sexual function
Being sexual with a disability
Unwanted or obsessive erotic attachment, jealousy, or loneliness
Becoming orgasmic, or more orgasmic
Exploring female ejaculation
Changing habitual sexual roles or scripts
Healing sexual abuse or trauma
Exploring erotic possibilities as a transitioning or transgender person, orsomeone who wants to play with gender
Addressing troublesome turn-ons, including “pornography addiction” orunwanted fantasies
Learning how to be safely and fully sexual when HIV–positive or withanother chronic STD
Learning about or exploring my anus/ anal sex/ prostate massageself-pleasuring coaching, expanding my self-pleasuring practicecommunicating desires exploring power and surrender as aspects of sex play and pleasure
As a Sexological Bodyworker, I am trained to do massage and varieties of bodywork that can include genital touch. This touch is offered only at the request of the student, and when deemed appropriate by myself as practitioner. Through erotic touch, sexological bodywork can assist students in developing presence within the body, opening interior awareness, and
learning how the body can become more and more alive. I offer experiential learning opportunities that consciously access profound ecstatic and erotic states. If bodywork might be part of your learning experience, please fill in the following information.

Do you have any of the following conditions? (Please select Yes or No)

Heart Condition
Vein or Artery Conditions
Breathing Problems
Are you taking any medication that could block pain or relax your muscles?
Are you currently suffering from any physical or emotional symptoms related to traumatic experience? If yes, please explain:
Do you have any sexual history, physical or mental illness, or other conditions that may affect your response to a bodywork session? If yes, please explain
Informed Consent and Agreement
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Yoga Therapy and Somatic sex education are not a substitute for psychotherapy or medical treatment.
I understand that any erotic touch will be given only at my request and solely for my own benefit, education and pleasure. I agree to guide Corinne’s touch to ensure that it is always beneficial, educational and pleasurable for me.
I have stated all medical conditions that I am aware of, and I will update Corinne on any changes in my health status.
Corinne does not act as a surrogate partner. She remains clothed during sessions. She uses her hands only to touch her students. She will never become romantically or sexually involved with a student.
Appropriate hygienic protocols will be used, including gloves for internal genital/anal touch.
Drugs and alcohol are not compatible with somatic sex education.
Cancellation Policy: 24 hours notice for cancellations is required or you will be billed for the session. Emergencies are exceptions.
I have read, understand and agree to the above statements
Your Name
Date completing this questionaire
After each session, Corinne suggests that you take notes about your experience. Write about practice (what happened), states (what you felt andexperienced), and distractions (distracting thoughts or impulses that tookaway your focus). Send a copy to Corinne. This will support your integration process and provide important guidance for future sessions.
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