Sometimes the intake form is glitchy and doesn't work the way it's supposed to. In that case, please copy and paste the following text and email your answers to me using the same email address you'll be using when you request sessions. Much gratitude!
First Name
Last Name
Phone Number
Pronouns/Gender & Age
Occupation (or previous, if retired)
How did you find this website?
Describe yourself in 3 words
Have we met before?
What calls you to this work?
What describes you? (multiple choices, no wrong answer)
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I'm looking to establish ongoing support in the relationship I have with my body
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I'm here to check things out and will consider returning after my initial visit
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I'm always thirsty for touch and get bodywork on the regular!
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This was recommended by another professional
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I live out of area and am looking for a one-time experience
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I don't have much bodywork/massage experience
What are you looking for? (multiple choices, no wrong answer)
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Relaxation + rest
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Bodycare (this is not massage therapy)
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Shameless gentle pleasure
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Experiential touch
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Recovery + connection
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Something else…
Of all the things mentioned on my site, what resonates? (multiple choices, no wrong answer)*
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Affirming touch
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Somatic awareness
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Erotic embodiment
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Energy + intuitive + spiritual care
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Affectionate surrogacy
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Sensual sovereignty
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Non-physical, no-touch communication
What else would you like me to know?
I have read and understand the Consent & Discretion Policy*
I understand by submitting this form, I can move forward with requesting a New Client session
Other Providers You've Seen (or Referred By)
Photo of Yourself or Business Card
Your Signature