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First Name
Last Name
Email
Phone Number
Age
Gender/ Identifying Gender
Location (City, State, Country)
WhatsApp/Telgram
What is your current profession or area of focus?
Which of the following best describes your current experience?
Are you wanting to do in person sessions, online or a combination of both?
In-person
Online
Combination
I'd be willing and able to come to Kauai for a VIP immersion day if invited
How did you find me?
Instagram
Facebook
EPIX Sex Life
Google Search
Referral
Other
What led you to seek me out? Is there something you're currently challenged with? How long have you been dealing with/struggling with this? How has this impacted your life?
How long have you been dealing with this? How has this impacted your life?
On a scale from 1-10, how committed are you to transformation and growth?
Do you have a personal practice for connecting to your own life force energy and body? (breathwork, movement, meditation, etc.)
What other types of healing modalities have you done before? (Select all the apply)
Reiki
Therapy
Coaching
Sensual Healing (massage, tantra, etc)
Other
Are you currently in a relationship/partnership? **If yes, read below before answering.
If I feel you would benefit from working with me and I sense you are ready and aligned, ideally when would you like to have your first session? What days and times generally work best for you?
As my sessions are very intimate, discretion and safety is paramount. Are you able to provide a business website, LinkedIn profile or other social media profile so I may verify who you are? Please add URLs below.
Do you have any physical limitations, challenges or health concerns I should know about?
Working with me is an investment in yourself. I have packages ranging from 4 figures all the way to 7 figures. Are you ready to go all in?
Yes
No
Is there anything else you would like to share before we meet?
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