Tantra Intake Form

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Tantra Intake Form

Please complete this form before receiving a Tantra session.

Email *

Full Name (First, Last) *

Date of Birth *

YYYY

Phone Number *

Emergency Contact (Name & Phone) *

Have you received a Tantra massage, yoni/lingam/anal massage, or any form of sacred bodywork before? If yes, please describe your experience.
*

⁠What is your intention for this session? (e.g., relaxation, healing, emotional release, deepening connection with self, etc.)
*

Are there any emotional or physical concerns you’d like to share before we begin?
*

This is a professional session where you are in full receptivity. You will not return touch to me, and there is no mutual exchange. Do you fully understand and agree to this boundary?
*

Yes, I agree.

No, I do not.

⁠Do you have any boundaries or requests that you would like me to honor during the session?
*

Is there any past trauma related to touch or intimacy that I should be aware of to ensure your comfort and safety?
*

⁠Do you have any medical conditions, injuries, or sensitivities I should be aware of? *

Are you currently experiencing any pain or discomfort in your body?
*

Are you pregnant or trying to conceive?
*

Yes

⁠How do you typically process deep emotional or energetic experiences?
*

Do you have any post-session support systems in place (e.g., journaling, meditation, therapy, or trusted friends)?
*

⁠I acknowledge that this session is not sexual or therapeutic in a clinical sense but rather a sacred and professional offering focused on energy and embodiment work.
*

Yes

I understand that all touch is one-directional, and I am here to receive. I will respect the space and boundaries of the practitioner. *

Yes

I confirm that I am participating of my own free will and understand that I may communicate my needs or stop the session at any time. *

Yes

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