Selfish Sexuality Intro Form
Please fill out this short form so I may be better prepared for our intro call. 
This is the start of embodiment revolution and our journey together. 
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Name *
Pronouns *
Sexual Identity *
Age *
Referred by *
Where are you located? If not Austin and desire in person sessions, please note if you plan to travel to Austin to bring me to you. *
What offering are you interested in? *
If Surrogate Partner Therapy, do you currently have a therapist that we will work with? *
Have you seen an intimacy guide before? If so, how was your experience? *
Pertaining to the physical body or emotional state are there issues that would be helpful for me to know (injury, illness, heartbreak, processing trauma)? If yes, please explain. *
Phone number *
Email *
Anything else you would like to share at this point?
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