Online Booking Form

Session Request Form

All fields must be answered.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
A LINK to your Social Media presence or business website. Social media must show your REAL NAME. I will not try to friend or connect with you there.*
Birthdate*

MonthDayYear
Date
May I send a text?

YesNo
Where did you see my ad or website?*
Do you have any past experience in your desired modality?*
What calls you to this experience? What are your intentions and desires?*
Do you have any physical or medical issues that could prevent you from moving your body easily? Are you pregnant? Any medications that affect the heart or blood pressure? Any allergies? Please let me know so I may adjust our session to best suit you. *
What is your passion in life?*
What are your pronouns? He/Him, She/Her, They/Them, etc. *
How long of a session are you desiring and what type?*
Desired Session Date/Time? Please keep in mind my business hours of Mon-Fri 11:30am-6pm*

DayMonthYear
Date
Hour MinutesAM/PM Option
Please verify that you are human*
Should be Empty:

Session Request Form