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Session application
I don’t work with everyone.
This form helps me feel whether this is the right space for us to enter together.
Name
*
What is your email address?
*
What is your phone number?
*
Have you had a session with me before?
*
Have you had a session with me before?
A
Yes
B
No
If you had a session with me before, please describe it briefly
Why are you drawn to work with me, and why now?
*
Where in your body do you feel the most tension or resistance right now?
*
Do you find it easy or difficult to let go of control in your body?
*
Do you find it easy or difficult to let go of control in your body?
A
Easy
B
Difficult
C
I don't know
Are you open to emotional release, stillness, silence, or unexpected feelings during the session?
*
Are you open to emotional release, stillness, silence, or unexpected feelings during the session?
A
Yes
B
No
C
I am curious
What do you hope to feel during this session?
*
Is there anything else I should know before deciding if we work together?
*
This space requires presence, respect, and emotional responsibility.
Please confirm you understand and agree:
*
Please confirm you understand and agree:
This is not a sexual service
No sexual release will take place during the session
I will fully respect the boundaries of the practitioner
I understand this is a body-based, emotional and experiential space
I agree to communicate honestly if something feels uncomfortable or unclear
I understand that I may not be accepted to work together
Is there anything you feel but haven’t said?
Submit
