• Form

  • Hello Sister, 

    I just want to let you know that this form is optional if you'd like to not fill the form in we can talk about everything in person over a cup of tea. 

    I work with a range of clients and it's my hope that you will feel comfortable expressing any concerns whilst we work together, please speak up if you need to go to the toilet or are uncomfortable, you are most welcome to ask questions, request pressure or tempreture changes, refuse things etc, I will check in with you throughout the massage also as I want you to feel comfortable, relaxed and respected. 

    Usually a session begins with a cup of herbal tea, yarning(talking) about your form, screening checking for any injuries or sesnstivities etc.

    Prices as follows:

    A Fertility massage alone is $200.00 (1.5hr)

    A massage and a yoni steam session is $350.00 (allow up to 2.5 hours)

    These prices are current as of Janurary 2026.

    A massage whenever you feel a deep desire for rest or a nervous system reset is wonderful and we also aknowledge that some women need regular weekly or fortnightly sessions to support them in their fertility or healing journey, If we believe it would be beneficail for you to have more frequent sessions we may suggest this at the end of your appointment,  in the case of reoccurring sessions we may be able to offer you a slight discount where possible.

  • Womb and Fertility Massage Check in.

    At the bottom of this we have also included a Yoni Steam intake form, please disregard if you’re not steaming.
  • Birthday:
     - -
    2 digit month, 2 digit day, 4 digit year
  • Would you like to be added to or newsletter list?
  •  -
  • The treatment you are booking in for is
  • Contraindications

    Please inform your therapist if any of the following are applicable, so that they can alter the treatment accordingly.
  • Tick any that apply
  • what areas would you like us to focus on in your visit?

  • Menstrual and fertility history

  • Are you experiencing any of the following?
  • Are you on hormonal birth control?
  • Have you heard of FAM Fertility Awareness Method?
  • Symptoms or conditions currently experiencing

  • Please tick all that apply
  • Symptoms experienced prior to and during menstruation

  • tick all that apply
  • Premenstrual Emotions

  • Do you find yourself experiencing any of the following in the week prior to your period or at any time if you are menopausal.

  • Digestive Health

  • please tick all that apply
  • Previous Pregnancy & Birth Herstory

  • Methods of delivery
  • Have you experienced
  • Your OWN birth story

  • How was your own birth & delivery experience?

  • Emotional & Spiritual

  • What areas would you like to see changes in?

  • Medical History

  • Please tick all that apply
  • Please read, confirm and sign before submitting your completed consultation form, Thank you !

  • GDPR Compliance 

    Your prsonal data will be stored and be accessible by Yoni Herbs Australia. 

    Your information will not be shared with any third party companies.

    We will only contact you with Regards to Yoni Herbs Australia/ Pulse of the Womb Massage and associated matters and will never send spam to you. 

     

    Medical Malpractice: Your details will be kept on record for 3 years once you have recieved your last treatement with Tessa Bobir. 

     

    Record Keeping

    Your consultuation forms are kept on file on a password protected computer, Your files are not viewed or accesible by anyone other than Tessa Bobir, unless consent is given by yourself. 

     

    Meedical Information Required

    The medical & emotional questions are required so that Tessa Bobir can provide holistic treamtent for you. You do not have to answer these questions if you do not wish too, for the saftey of Tessa and insurance purposes some questions not being answered eg, if you have recently had surgery, may result in a session having to be cancelled, or resheduled, which is up to the discretion of the massage practitioner at the time.

  • I have read and agree to the GDPR compliance
  • I have stated all known conditions and take it upon myself to keep Yoni Herbs Australia/ Pulse of the Womb updated on my health
  • I understand that Fertility and Womb massage therapy is not a replacement for medical care
  • As such Tessa Bobir does not prescribe medical treatment, pharmaceuticals, nor does she perform spinal manipulation.
  • I understand that Tess Bobir does not diagnose medical illness, disease, or any other physical or mental conditions.
  • I agree to be punctual, respectful and orderly
  • I agree to finalise all payments prior to leaving the massage session
  • YONI STEAM QUESTIONNAIRE

    This information helps us to create your personalised Yoni Steam Session and screen for sensitivities.
  • do you know how to chart your menstural cycle
  • Contraindications
    Rows
  • please mark all that apply
    Rows
  • please mark all that apply
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  • Indicators for Cleansing
    Rows
  • Indicators for Gentle
    Rows
  • Indicators for Disinfecting
    Rows
  • indicators for cooling hers
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  • if your period is absent, what is the reason?
  • Are you breastfeeding?
  • How were your birth experiences?
  • WAIVER 


    PLEASE READ]


     


    Most of the side-effects reported while steaming are positive. Users have reported better sleep and lucid dreams, relaxation, decreased swelling in legs and feet, decreased abdominal bloating, slimmer waistline, increased libido and sexual sensation; increased vaginal nectar and fertility, decrease in breast soreness, fewer headaches, fewer PMS symptoms and improved emotional balance, increased circulation and energy, tingling feet, glowing skin, reduction in incidence of hormonal acne and increased lubrication and vaginal nectar, scar softening, tighter vaginal canal and harmonization with the moon cycle.


     


    WHAT TO EXPECT


    Steaming is a cleanse. Some of the possible signs the vaginal steaming is working is if you experience -- the urge to urinate while steaming, brown discharge after steaming, increased clots or cramps during the period, increased dry cramps, increased irregular vaginal discharge (white, green, thick, clumpy), emotional release, periods that come earlier or later than expected. All of these signs are a normal part of the cleansing process and these signs will go away once the cleanse is complete. Please note these changes and let your practitioner know of these positive changes


     


    ..BEST PRACTICES


    1) Go to the bathroom directly prior to vaginal steaming


     
    2) Learn proper period care. 

    Book in for menstrual health education, Learn how to better care for yourself during your menstrual cycle, by Learning body literacy and charting the menstrual cycle using Fertility Awareness Method. 


    3) Increased vaginal discharge can be addressed by using cotton underwear liners and a peri-bottle throughout the day to clean mucus off the skin.

     


    CAUTION SIGNS


    If steaming causes a rash, bumps, headaches itchiness, diarrhea or the onset of fresh spotting or inter-period bleeding, this could be a sign that your steam protocol or herbs might need to be adjusted or that there is an allergic reaction. If these signs occur please let your practitioner know so they can adjust the steam session as necessary or make a referral.


    ****


    In 99% of all cases using a mild steam session and mild herbs will prevent any of the above signs from happening so it's very important that you give honest answers in this intake form so that the practitioner can set up a steam session that will fit your needs.


    ****


     
    Note: It is best practice to check that your vaginal steam specialist has a Vaginal Steam Facilitator certificate in good standing. This certification ensures that your practitioner knows the proper safety standards regarding setting up a vaginal steam session tailored to fit your needs. Please check the Vaginal Steam Directory (www.vaginalsteamdirectory.com) to ensure that your practitioner has a valid certificate. The Peristeam Hydrotherapy Institute keeps an up-to-date list of all certified practitioners on the directory so if they are not on the map it's possible that the certificate is fabricated.


    I understand that vaginal steaming may have positive or negative side effects as a result of doing a vaginal steam session. I accept legal responsibility for my choice to do a vaginal steam session and waive the responsibility of the practitioner and the facility where the steam session takes place in the case that any of the named side effects (or others) may occur.

     

    I agree that this is a legally binding document. My printed name and date below represent my signature.

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • PRACTITIONER USE ONLY:
    Rows
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: