Lotus Love Tantra Intake Form

Lotus Love Tantra Intake Form
Section 1: Welcome & Personal Information
Welcome.

This intake helps determine whether we are a strong fit to work together and clarifies your intentions, history, and readiness to engage in private sessions.

Please answer honestly and directly, as if writing in your journal or speaking to someone you know well and trust. There are no right or wrong answers, only what is true for you right now. The more direct and honest you are, the more useful our time together can be.

All information is held confidentially.
Individual sessionCouples session (both partners will complete a form)Ongoing workImmersionUnsure
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone
Format: (000) 000-0000.
EmailTextPhone
Best times to reach you
Current Address (Street, City, State, Country, Zip)
Do you have children? If yes, please list ages and share anything relevant about your relationship with them.
Date of Birth*

MonthDayYear
Date
Place of Birth
Time of Birth (if known)

Minutes Minutes

AM/PM Option
Emergency Contact Name and Number*
How did you find/hear about me?*
Section 2: Identity and Work
How would you describe your current professional life or vocation?
FemaleMaleHermaphrodite
Current Genital Anatomy (if relevant to our work)
How would you describe your sexual orientation?
Section 3: Relational & Emotional Landscape

These questions help me understand how you relate, respond, and move within intimacy and connection.
YesNo
If yes, how would you describe the dynamics at this time?*
YesNo
YesNoUncertain
Briefly describe the relational environment you grew up in and how you tended to respond within it. (Parents, siblings, or anyone significant in your early life.)
Looking back at your intimate relationships, what patterns have you noticed, if any?
When conflict or strong emotion arises in relationship, how do you tend to respond?*
Are there significant experiences that have shaped your relationship to intimacy or trust?
What experience, if any, have you had with therapy, counseling, or other personal growth work? Please include the length of time and any approaches you’ve worked with.*
Section 4: Intention & Timing
What brings you to seek private sessions at this time? What feels important about reaching out now?*
Section 5: Physical & Sexual Health
Describe your current physical and sexual health. *
YesNo
If yes, please briefly describe.
List any current medications that may affect your physical, emotional, or sexual functioning.*
YesNo
If yes, please briefly describe.*
YesNo
When were you last tested, and were the results clear?*
YesNo
YesNo
Approximate date of last vaccination or booster

MonthDayYear
Date
YesNo
If yes, please briefly describe and share how it is being managed currently.
YesNo
If yes, please briefly describe.
Anything I should know about your body or physical health before we work together?
Section 6: Erotic & Sexual Experience

These questions help me understand your erotic and sexual experience so I can guide you skillfully and responsibly.
Which types of orgasmic experiences have you had?
Check all that apply. You may include solo and partnered experiences.
ClitoralVaginalCervicalBlended (Clitoral and Vaginal at the same time)Ejaculatory MenEjaculatory Women ("Amrita")AnalProstaticFull BodyMultipleG-Spot/Sacred Spot
How would you describe your overall orgasmic capacity and any challenges?*
What do you typically feel or experience, and how do you express yourself at the moment of orgasm?
How would you describe your relationship to self-pleasure?
Are there forms of erotic expression you have explored or feel curious to explore?
Section 7: Tantra & Practice Orientation

This section helps me understand your familiarity with Tantra and contemplative practices.
What is your understanding of or experience with Tantra?*
YesNoUnsure
Briefly describe your relationship, if any, to meditation, yoga, spiritual, or contemplative practices that have been meaningful in your life.
Section 8: Life Inventory

Please rate how these areas of your life feel right now. 1 = Under strain 5 = Strong and steady
Emotional & Mental Health
Physical Health
Body & Sexuality
Intimate Relationships
Community & Friendships
Work, Purpose, & Creativity
Finances
Spiritual Life
Play & Enjoyment
Would you like to share more about any of the areas above?
What feels most ready for attention or change in your life right now?
Section 9: Readiness & Intentions
What patterns, challenges, or tensions feel most present in your life right now?
What would feel like meaningful change or growth for you at this point in your life?
Private sessions are extended, focused time within a well-defined container where you can meet yourself as deeply as you’re ready.

On a scale of 1–10, how ready do you feel to commit to focused, honest sessions at this time?

1 = unsure or hesitant
10 = fully ready and prepared to commit
What supports that readiness? If anything gives you pause, briefly describe it.
Is there anything important you would like me to know that has not been asked here?
Section 10: Availability & Scheduling
MorningMiddayAfternoonEveningsVaries
Are there specific days of the week that work best for you?
Are there specific dates you're hoping to begin?
If your availability varies, please briefly describe.
Section 11: Immersion Inquiry

Immersion is extended, private work built for continuity and depth. Spending dedicated time together allows momentum to build and insight to integrate in ways single sessions cannot support. Rather than working in isolation, immersion creates a cohesive arc. This format is best suited for those who value sustained focus and deeper continuity.
What draws you toward immersive work at this time?
One full dayTwo to three consecutive daysFour or more daysI am unsure and would like to discuss
What timeline are you considering for immersive work?
Where are you envisioning immersive work taking place? Immersion may take place in Colorado or another mutually chosen location.
Is there anything that could meaningfully affect your ability to participate in immersive work as described above?
If this immersive experience met you at the level you are ready for, what would feel different in how you inhabit your body, your relationships, or your life?
Thank you for your thoughtful responses. I appreciate your openness and the care you’ve taken in completing this form. Once I’ve reviewed your intake, I’ll be in touch about next steps.

Sincerely,

Ann Vajradakini
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Lotus Love Tantra Intake Form

Section 1: Welcome & Personal Information

Section 2: Identity and Work

Section 3: Relational & Emotional Landscape

Section 4: Intention & Timing

Section 5: Physical & Sexual Health

Section 6: Erotic & Sexual Experience

Section 7: Tantra & Practice Orientation

Section 8: Life Inventory

Section 9: Readiness & Intentions

Section 10: Availability & Scheduling

Section 11: Immersion Inquiry