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First Name
Last Name
Email
Age
Gender/Identifying Gender
Where do you currently reside? (Country, State & City)
Phone Number (Area code, plus country code if outside the US)
What is your preferred time of day for calls/texts?
Morning
Afternoon
Evening
Can you share a little bit more about your profession?
Are you looking for a couples session? If yes, what are you looking for?
Are you wanting to do in person sessions, online or a combination of both?
In-person
Online
Combination
I'd be willing and able to come to Kauai for a VIP immersion day if invited
How did you find me?
Instagram
Facebook
EPIX Sex Life
Google Search
Referral
Other
What led you to seek me out? Is there something you're currently challenged with? How long have you been dealing with/struggling with this? How has this impacted your life?
On a scale from 1-10, how committed are you to transformation and growth?
Do you have a spiritual practice? If yes, what do you do?
What other types of healing modalities have you done before? (Select all the apply)
Reiki
Therapy
Coaching
Sensual Healing (massage, tantra, etc)
Other
Are you currently in a relationship/partnership? **If yes, read below before answering.
If I feel you would benefit from working with me and I sense you are ready and aligned, ideally when would you like to have your first session? What days and times generally work best for you?
As my sessions are very intimate, discretion and safety is paramount. Are you able to provide a business website, LinkedIn profile or other social media profile so I may verify who you are? Please add URLs below.
Do you have any physical limitations, challenges or health concerns I should know about?
Are you comfortable being naked?
Working with me is an investment in yourself. I have packages ranging from 4 figures all the way to 7 figures. Are you ready to go all in?
Yes
No
Is there anything else you would like me to know?
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