Client Application Form
Greetings Beloved!  
Congratulations on taking the first step to reclaiming your Erotic power and access to full unabashed pleasure!
Please complete the Client Application Form below.  

Everything you share with me is 100% confidential and helps me to have a better understanding of what you desire and if we're a good fit for this journey of exploration. A pillar of my practice is holding an impeccable sacred space of non-judgement and acceptance for your sharing, so please know this a safe place to share anything with me you feel is important to the transformation you're seeking.

Sending so much love and looking forward to connecting with you!

Beth
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Email *
Name *
Pronouns *
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Telephone Number *
May I text you? *
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Please choose one. *
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Please describe you relationship/love life as it is right now. *
If you could have your ultimate relationship/love life in the next 12 months, what would it look like? *
What do you desire to create for yourself or achieve by working with me? *
Why do you desire to work with me as your Pleasure Coach? *
What challenges are stopping you from creating what you desire? *
How are you holding yourself back? *
Are you actively struggling with depression, suicidal thoughts, an eating disorder, or any other mental health conditions? Are your currently receiving or seeking professional help or support?  (Please note that I am not a therapist and not qualified to treat mental health conditions. If you're actively struggling with mental health conditions, I require that you're seeking professional treatment for us to work together.  I'm also happy to connect you with a qualified professional if you need referrals.  Please don't hesitate to ask me for support with this.) *
What are the current strategies/practices you are using to enhance/improve your love life? How are they working for you? *
Have you participated in other coaching programs? If yes, with whom and what was your experience? *
Tell me why you are ready NOW to dive into getting support and transformation? *
A copy of your responses will be emailed to the address you provided.
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