Application Form

Welcome, Sacred Seeker!!

This form is the first step in your journey together – a space to honor trust, clarity, and mutual respect. This screening process ensures that we are aligned in energy, intention, and safety. It is not about judgment – it is about discernment, integrity, and honoring the space in which you will be. Complete all questions honestly. Your information is kept strictly confidential and will never be shared.

Note: sessions are offered to those who are willing to prove their identity and who engage in respectful, conscious communication. Couple? Both are required to fill out this form.

Once your responses are received, your form will be reviewed in 24-72 hrs. Once verified, a 20-minute call is required for a $50 fee. The $50 goes towards your 1st session when scheduled within 2 weeks. Couple? Both must be on the call. Beyond two weeks, it is a token for my time.

Deposits depend on the type of session, the length of the session, and any add-ons. All deposits are nonrefundable.

If you do not hear back within three days, please check your spam and junk folders first. Whitelist our email.

What brings you here?

What is the best way to get a hold of you? You will not be contacted outside my business hours. Your first contact from me will be by email, informing you of your acceptance.

Tell me about yourself. What made you consider reaching out to me? What intrigues you about Tantra, Bondassage, or any other service listed on my website? This is a sacred service. Mentioning my physicality is disrespectful and not tolerated.

What would you like to see accomplished within your sessions? Anything specific you were having concerns or issues with in your sexual, mental, and physical health? This helps guide me on how to proceed within sessions.

Are you taking any medication? If so, what for and for how long? Does any of the medication you take affect your libido?

What type of surgeries have you had, if any? What for? Date or year?

Have you been diagnosed with any physical condition, disease, or mental disorder? This information is important for me to know to best serve you in the psychosomatic bodywork you are about to experience.

What is your experience with somatic bodywork, Tantra, breathing techniques, yoga, meditation, sound, healing, or other holistic healing techniques?

If you are hoping to experience a 1 - 3 day immersion, will you book a follow-up coaching call/Zoom session (FREE) with me in the days that follow so you can unpack what happened during our time together?

YES

MAYBE

If you are in a relationship, are you aware that the services offered to you on my site have the potential to change how you relate to your partner?

YES

If you have seen providers within the past year, provide their name, website, and email. Ask their permission first. Some allow this, while others don't.

Enter a LinkedIn profile. Must have image with at least 500 followers. Other option is your business or company website where you work, or an active social media account that shows your face picture.

When would you like to schedule? NO SAME DAY ALLOWED. Business hours are M-F 9 am - 8:30 pm. Saturday 9 am - 3pm Sunday - Closed

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Failure to supply the above information risks this application being disregarded and thrown in the trash. Your ID must be clear and visible. You may block out the street only. I need to see DOB, city, state, zip, and profile image.

Please know that deposits are nonrefundable, as they reserve your appointment time. You agree to pay $50 for your 20 minute initial consult. Appointment will not be set without this call.

You agree to these terms.

Cancellation Policy

If you cancel within 48 hours of your scheduled appointment, 50% of the total fee is due.

If you cancel within 24 hours, for any reason, the full session fee is required before scheduling future appointments.

This ensures that reserved time is respected and that scheduling remains fair for all clients.

By completing, and signing this application form, you acknowledge and agree to this cancellation policy. If any payment due under this policy is not made, communication will cease.

Upload Government ID clearly showing DOB, city, state, zip, and image of face.

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Please upload an image of your face so I can see it matches the ID.

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I have filled out this form honestly and completely, have read and understand your cancellation policy, booking procedures and that I am a legal adult over the age of 21.

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