New Customer Registration Form

New Clients - Couple's Private Sessions

Welcome to Byron Bay Couple's Retreats & Private Sessions.
Full Name *

First Name Last Name
Name of Partner

First Name Last Name
Town/Place of Residence:
Phone Number *
E-mail
example@example.com
How would you like me to contact you?

Email Phone
How did you hear about Byron Bay Couple's Retreats?

Recommendation Google Search Website Facebook/Social Media
What type of sessions are you wanting to book?

Introduction To Sacred Sexuality & Tantra 2 Hours Relationship Counselling & Sex Education 90 mins Hands On Sexual Embodiment Tuition 4 Hours Heart Connected Sexuality Program (6 Session Series) 14 Hours Other - Please detail below
Delivery Method:

Online via Zoom or Skype Face to Face Both Online & Face to Face
How long have you been in relationship?
Tell me a little about you. Please provide any information that you think would be helpful for me to know, prior to your sessions.
Session Goals: What would you like to walk away with from your sessions?
For session scheduling, what dates suit you best? *
Would you like to have an information call with Eve prior to making a booking?

Yes No
Additional Comments or Special Requests:
Thank you for taking the time to fill in this form. All information is strictly confidential and is only utilised for the purpose of supporting you in your experience of private sessions.

Looking forward to meeting you both,

Kind Regards,

Eve

Byron Bay Couple's Retreats
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New Clients - Couple's Private Sessions