Sacred Center Yoga

Yoga Therapy for Sexual Wellness and Somatic Sex Education

Yoga Therapy for Sexual Wellness is the process of empowering individuals to

progress towards improved health and well being through the applications of the

philosophy and practice of yoga. Sessions can include coaching in breath,

movement, body awareness, boundary-setting, communication, anatomy, sensate

focus, massage, erotic trance and other body-based teaching about sexuality. Yoga

Therapy for Sexual wellness is designed to nurture, deepen or awaken the sensual

self.

Today's date:* This field is required.

Date

Full Name or Pseudonym* This field is required.

First Name

Last Name

Phone Number* This field is required.

Area Code

Phone Number

E-mail* This field is required.

Occupation* This field is required.

Birth Date* This field is required.

Date

How did you hear about my practice?* This field is required.

What are your Intentions for working with me? Your intentions might be your goals, hopes, dreams, wildest fantasies, these can change as we work together. .

Would you like to explain any specific health problems or challenges in your life?

Tell me a little about your lifestyle? Diet? Exercise program? Do you smoke or drink?

How is your breathing?

How would you describe your energy levels?

How is your stress level?

How do you have fun in your life?

Do you have a spiritual practice or a sense of the sacred that is part of your life? What is the role of sexuality within this (if any)?

Difficult things from my sexual/sensual history I want you to know are:

Wonderful things from my sexual/sensual history I want you to know are:

Difficult things about my current sexuality/sensuality I want you to know are:

Wonderful things about my current sexuality/sensuality I want you to knoware:

On a scale of 0-10, how well do accept your body as it is? (0 = No acceptance 5 = Moderately accepting 10 = I love and accept my body exactly as it is.)Add details about your body-image.

Tell me about your intimate relationship/s.

Scars from abdominal surgery, childbirth, trauma and circumcision can affect sexual function. Do you have any scars on your body that you might want to have worked on? If yes, please describe the scar and when it occurred.

Please add anything else you would like me to know about your sexual history or current desire patterns, including gender identity, sexual orientation(s), self-pleasuring practices, fantasies, use of pornography, or any other information that you feel may be relevant.

Exploring who I am as an erotic being

Passionate Relationship, expanding possibilities for couples

Massage Lessons for Lovers, learning the arts of sacred touch

Learning the anatomy of arousal

Experiencing and learning Tantric techniques

Experiencing and learning Taoist Erotic Massage

Exploring the intersection of sex and spirit

Orgasmic birth coaching

Loss or lack of sexual desire – inside or outside of relationship

Healing female sexual dysfunction, erectile dysfunction, premature ejaculation, inhibited ejaculation

Reconnecting to sex after childbirth, menopause, or prostate surgery

Learning to experience and give a partner extended and multiple orgasms

Deciphering sexual identity

Chronic pelvic pain, vulvodynia, constrictions that inhibit sexual function

Being sexual with a disability

Unwanted or obsessive erotic attachment, jealousy, or loneliness

Becoming orgasmic, or more orgasmic

Exploring female ejaculation

Changing habitual sexual roles or scripts

Healing sexual abuse or trauma

Exploring erotic possibilities as a transitioning or transgender person, or someone who wants to play with gender

Addressing troublesome turn-ons, including “pornography addiction” or unwanted fantasies

Learning how to be safely and fully sexual when HIV–positive or with another chronic STD

Learning about or exploring my anus/ anal sex/ prostate massage

Self-pleasuring coaching, expanding my self-pleasuring practice

Communicating desires

Exploring power and surrender as aspects of sex play and pleasure

Other

Do you have any of the following conditions? (Please check the box for those that apply)

Pregnant

Osteoporosis

Inflammation

Heart Condition

Arthritis

Diabetes

Vein or Artery

Conditions

Breathing problems

Pain

Scars

Epilepsy

Allergies

Are you taking any medication that could block pain or relax your muscles?

Yes

Are you currently suffering from any physical or emotional symptoms related to traumatic experience?

Yes

If yes, please explain:

Do you have any sexual history, physical or mental illness, or other conditions that may affect your response to a bodywork session?

Yes

If yes, please explain:

Yoga Therapy and Somatic sex education are not a substitute for psychotherapy or medical treatment.* This field is required.

Clear

I understand that any erotic touch will be given only at my request and solely for my own benefit, education and pleasure. I agree to guide Corinne’s touch to ensure that it is always beneficial, educational and pleasurable for me.* This field is required.

Clear

I have stated all medical conditions that I am aware of, and I will update Corinne on any changes in my health status.* This field is required.

Clear

Corinne does not act as a surrogate partner. She remains clothed during sessions. She uses her hands only to touch her students. She will never become romantically or sexually involved with a student.* This field is required.

Clear

Appropriate hygienic protocols will be used, including gloves for internal genital/anal touch.* This field is required.

Clear

Drugs and alcohol are not compatible with somatic sex education.* This field is required.

Clear

Cancellation Policy: 24 hours notice for cancellations is required or you will be billed for the session. Emergencies are exceptions.* This field is required.

Clear

After each session, Corinne suggests that you take notes about your

experience. Write about practice (what happened), states (what you felt and

experienced), and distractions (distracting thoughts or impulses that took

away your focus). Send a copy to Corinne. This will support your integration

process and provide important guidance for future sessions. Please send to:

sacredcenteryoga@gmail.com

I acknowledge and accept all the terms outlined in this waiver.