Name * First Name Last Name Email * Phone (###) ### #### What services are you interested in? Somatic Bodywork Empowered Lifeforce Coaching Conscious Loveship Preferred Date MM DD YYYY Enter city and state of residence * What is your age? * What is your gender and pronouns? * What is your profession or line of work? * For Conscious Loveship Offering: Please share any specific needs, desires, fantasies, scenes or forms of connection that call you to this offering. If applying for another offering, enter NA. * Are you currently in an intimate relationship? (committed, monogamous, open, poly) If so, what is the status of the relationship? Hows's it going? * What do you want to experience AND OR heal in your life, intimacy, sexuality, or relationships? Please be as detailed as possible. * What is your experience or knowledge of tantra or sacred sexuality? * Describe any chronic pain, ongoing physical conditions, or injuries. If none, enter NA * Why do you think you don't have what you want yet? * Tell me about any history of abuse and trauma, as you understand it. * If you could wake up as a new person with a new life, and have change in yourself, or your life...what would you change? How would you be different? * Have you worked with plant medicine, a coach, therapist, shaman, or sexual healer on what you have mentioned in this form? If so what was the outcome? * By bringing this area of your life into deeper alignment what do you imagine the impact to be on your personal or professional life and financial abundance? * What is your relationship to self-pleasure and pleasure like? * Please list any significant life challenges (i.e. Divorce, Unwanted Sexual Encounters, Addiction, Bullying, etc.) * Have any questions? Thank you! Apply to Initiate Change
