Sexology Session Application

Sexology Session Application
Thank you for your interest in working with me.

I agree to work with clients based on my ability to meet their individual needs and our compatibility to work together.

Please answer all questions to the best of your ability. I respect your privacy - all information you provide below is completely confidential and will not be shared with anyone.

If your application is accepted, I will contact you via email within 3-5 days to schedule a 20-minute consultation call ($30) over the phone so I can give you a better idea of what you can expect from our sessions, answer any questions you may have for me, and let you know what the next steps are for moving forward.

This application is for individual clients only - Couples Session applications can be found here
Name*

First NameLast Name
Email*
example@example.com
Phone number

Area CodePhone Number
Date of birth*

MonthDayYear
Date
What city do you currently you reside in?*
Do you have access to the internet?*

YesNo
Are you applying for*

In-person in Los AngelesOnline//virtualBoth
What types of sessions are you interested in?*

Individual SessionsPartner SessionsIn-person in Los AngelesOnline//virtual
If applying for Partner Sessions, what is your partner's name?
When are you potentially interested in booking your first session?*
Please note that I am typically booked out 5-10 days in advance depending on the time of year
What days and time frames are you generally available to meet?*
I have flexible availability on both weekdays and weekends.
What is your gender?*

cis womantrans womancis mantrans mannon-binarygender-fluidOther
What are your sexual orientations/identities?*

heterosexualhomosexualbisexualpansexualpolysexuala-sexualcurious//exploringOther
What is your current relationship status/orientation? (Select all that apply)*

singledatingin a monogamous relationshipin a non-monogamous//open relationshipin a monogamous marriagein a non-monogamous//open marriagedivorcedrecently ended a relationshipcelibatemonogamousnon-monogamouspolyamorousOther
What religious//spiritual//philosophical beliefs do practice//align with?*

BuddhismJudaismChristianityIslamHinduismTaoismPaganismWiccaMysticismStoicismAtheismAgnosticismOther
Are you currently working or employed?*

WorkingSelf-employedNot workingOther
How many hours per week do you work?*

01-1212-3030-4040+
What issues are you currently dealing with or have you dealt with in the past? (Select all that apply)*

AnxietyDepressionPost-traumatic stressAnger issuesSubstance abuse//addictionCodependencyLow libidoCompulsive masturbation//sexual activityPorn addictionInfidelityErectile dysfunctionPremature ejaculationVaginismus (pain during vaginal penetration)Anorgasmia (inability to orgasm)Disassociation during sexUrinary incontinenceTrauma (physical, emotional)Abuse (physical, emotional)Sexual traumaMood disorderPersonality disorderChronic painChronic fatigue
Are you currently working with a therapist, counselor, social worker, or other licensed mental health professional?*

YesNo
Have you ever worked with a therapist, counselor, social worker, or other licensed mental health professional?*

YesNo
Are currently taking any prescription medication? If yes, what?
What areas would you like to focus on? (Select all that apply)*

Cultivating presence in and out of the bedroomConnecting more to pleasure both non-sexually and sexuallyEnhancing libido/sex driveEnhancing sensationExpanding orgasmic potential/becoming multi-orgasmicLasting longer in bedSemen retentionImproving communication skillsSelf-love/self-compassionFeel more comfortable in body, self-expression, sensuality, and sexualityFeel more attractive/magnetic sexuallyPerformance anxiety
Why are interested in a holistic, somatic, and Tantric approach to sex? What would you like to achieve?*
Is there anything else you would like to share with me?
Should be Empty: