CONSCIOUS CUDDLING CLIENT INTAKE & SCREENING FORM
Date:
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Month
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Day
Year
Date
Full Legal Name:
Phone Number:
Format: (000) 000-0000.
Have you ever used a professional cuddling service before?
Yes
No
If yes, please briefly describe your experience:
What brings you to conscious cuddling services?
Stress relief
Loneliness
Emotional support
Relaxation
Personal growth
Comfort during life
Other
What are you hoping to gain from our sessions?
Are you comfortable participating in a strictly platonic, non-sexual service?
Yes
No
Do you understand that this service is not dating, therapy, escorting, massage therapy, or a romantic relationship?
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Yes
No
Do you understand that any sexual behavior, sexual requests, or repeated boundary violations will result in immediate termination of the session?
Yes
No
Have you ever been convicted of a violent crime?
Yes
No
If yes, please explain:
Are you currently under the influence of alcohol or drugs?
Yes
No
Are there any medical conditions, injuries, trauma triggers, touch sensitivities, or concerns that I should know about to help create a safe experience?
Do you agree to attend a public meet-and-greet prior to your first session?
Yes
No
Do you agree to present government-issued identification upon request?
Yes
No
Did you read the Cuddle Comfort terms and conditions and do you agree to them? Here it is: https://www.cuddlecomfort.com/terms/client-service-agreement/
Yes and yes
No
Client Signature:
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Date:
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Month
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Day
Year
Date
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