New Client Intake Form

New Client Intake Form

Tantra is a way to explore and expand your capacity to experience blissful, energetic awareness in the body. This work can create life-changing shifts in every area of your life; not just within your body, but also in your relationships, emotional well-being, and spiritual growth. My intention is to offer healing, consciousness expansion, education, and direct experiential understanding through Tantric practices. My safety is your safety. I work out of private live/work spaces (not storefronts), and because of that, I move with care and discernment. Just as you would not invite unknown strangers into your private home without trust, screening, or some sense of who they are, neither do I. Screening is in place to create a safe sanctuary. One where you can fully let go, unwind, and leave the cares of the outside world behind. I hold an intentional, peaceful environment that supports real healing and true Tantric transformation. I do not accept all applicants. Just as you choose your practitioners with care and discernment, I also choose my clients with the same respect and consideration.
Name

First NameLast Name
Phone Number
Please enter a valid phone numberFormat: (000) 000-0000.
Email
example@example.com
What is your profession?
What is your experience with Tantra and bodywork?
What made you want to reach out and work with me?

Please share your LinkedIn, professional website with your photo in it, AND/OR a social media account you are active on. An alternative would be to share TWO references from other Tantra service providers that you have worked with in the past year. Share their name, number, and email below.

Rows	LinkedIn, website, Social media, references
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Please upload an unobstructed picture of the front of your ID or passport.

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If I google your name and town, will anything show up to verify you are who you say you are and do what you say you do?
If your application is accepted to you promise to be discreet, respectful, and honoring of your therapists time, energy, and boundaries?
Your privacy is important to me. The information shared in this form is used for verification purposes only and is handled with the utmost care. All forms are encrypted for your security, and anything shared through emails, sessions, or intake forms remains strictly confidential. For high-profile clients, I am also willing to sign an NDA if needed.

By submitting this form, you agree to move forward with mindfulness, care, and mutual respect. Once your form has been reviewed, you will receive an email shortly with further details to book your first appointment.
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