Your Sensual Wisdom Intake Form

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Welcome! (optional)

I look forward to learning more about you...

Contact Information (optional)

Please provide your name and contact details below

First and last name

Email address

Preferred phone number (optional)

Country code

Phone number

Gender (optional)

Male

Female

Couple

Age(s) (optional)

Occupation(s) (optional)

How did you find me?

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Referral

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Best times to reach you for our initial phone call? (optional)

Do you have any questions you'd like to discuss during our call? (optional)

Q&A

Thank you for your interest in my work. To the best of your ability I would love for you to answer the following questions. It’s a simple way for me to get to know you a little better. Answer as completely and authentically as you can. I will follow up with you by phone for a free mini-consultation to determine how we might best work together. Your privacy is very important to me. Any information given to me will be treated with the utmost confidentiality and respect.

Please describe why you are interested in working with me. (optional)

What issue/s would you like my support with? (optional)

What would you like to change about your current situation? (optional)

What do you feel has blocked you from experiencing this before now? (optional)

What will you have achieved, accomplished, acquired, and/or become at the end of our time together that would have you know our work together was worth every second and every penny to you? *

Do you have experience with any of the following: (optional)

Tantra

Meditation

Breath Work

Massage

Dance

Yoga

Martial Arts

Non-Violent Communication

NLP

Reiki

Other (please specify below)

If yes to any above, please tell me a little bit more about that/those experience(s): (optional)

How do you feel about your body and general health? (optional)

Describe your relationship with your emotions. (optional)

Do you consider yourself spiritual or religious? If so can you tell me a little about what this means to you? (optional)

Are you currently single, dating, in partnership, married, or other? (optional)

At times the work we do together may be challenging. Are you willing to move through this if it means we are making progress? (optional)

Is there anything else you would like me to know about you? (optional)