Name (First & Last)

Email Address

Phone Number

Emergency contact first name and phone number (if needed, I will identify myself only as a "practitioner")

How did you hear about my practice? How did you hear about my practice?

Intentions & Goals Your intentions and goals will guide this work. It’s okay to know exactly what you want and it’s okay to not be 100% sure. Either way, we will explore it as we walk together. That said, it’s helpful to know what generally brings you to this work. Share as much as you feel comfortable sharing about your intentions and goals in starting this work with me:

What are the most difficult aspects of your sexual/sensual history? How do they affect your present expression? What are the most difficult aspects of your sexual/sensual history? How do they affect your present expression?

What are the most wonderful aspects of your sexual/sensual history? How do they affect your present expression? What are the most wonderful aspects of your sexual/sensual history? How do they affect your present expression?

What would you like to tell me about your history of work in the realm of sexuality? Examples might include: A peak erotic experience Sexual or other trauma and how it affects you Your history with sex therapy and/or erotic bodywork (sexological bodywork, sensual massage, sex workers, sexual surrogates, tantra, etc.) Injuries to your body and how they affect you Your relationship to the divine (spirituality) What would you like to tell me about your history of work in the realm of sexuality? Examples might include: A peak erotic experience Sexual or other trauma and how it affects you Your history with sex therapy and/or erotic bodywork (sexological bodywork, sensual massage, sex workers, sexual surrogates, tantra, etc.) Injuries to your body and how they affect you Your relationship to the divine (spirituality)

Share a bit about the primary romantic relationship(s) in your life right now and the joys and struggles you experience through them: Share a bit about the primary romantic relationship(s) in your life right now and the joys and struggles you experience through them:

What significant relationships in your past, romantic or platonic, come up frequently in your present-time relationships? What significant relationships in your past, romantic or platonic, come up frequently in your present-time relationships?

Describe one big dream or vision that you have for your life and/or your sexual self. What is it that you feel you came here to do? Don't worry if you feel this is unattainable, irrational, or nonsensical, just share from the raw part of you that wants what it wants. Describe one big dream or vision that you have for your life and/or your sexual self. What is it that you feel you came here to do? Don't worry if you feel this is unattainable, irrational, or nonsensical, just share from the raw part of you that wants what it wants.

Bodywork Bodywork As a somatic sex educator in training I offer erotic touch at the request of the client and when deemed appropriate by me. Through this touch, I can assist clients in developing presence within the body, opening interior awareness, and learning how the body can become more and more alive. I offer one-way touch that can consciously access profound ecstatic and erotic states. This work is around guiding you to understand what works for your body and what you truly want to receive. Are you interested in receiving bodywork as part of our time together? Yes No Maybe/I Don't Know

Do you have any of the following conditions? Do you have any of the following conditions? Currently Pregnant Osteoporosis Inflammation Heart Condition Arthritis Diabetes Vein or Artery Conditions Breathing Problems Pain Epilepsy Recent Surgery Allergies (specifically to latex, certain oils, such as coconut, or essential oils) Genital Pain Taking medication that could block pain or relax your muscles Currently suffering from physical or emotional symptoms related to traumatic experience Other

Informed Consent & Agreement Informed Consent & Agreement Erotic Alchemy is educational in nature is not psychotherapy or medical treatment. I understand that any erotic touch will be given only at my request and solely for my own benefit, education and pleasure. I agree to guide your touch to ensure that it is always beneficial, educational and pleasurable for me. I have stated all medical conditions that I am aware of, and I will update you on any changes in my health status. I am aware that appropriate hygiene protocols will be used, such as gloves, sanitized lubricant and toys, etc. I understand that drug and alcohol use is not compatible with Erotic Alchemy work (with the possibility of exploring psilocybin and cannabis under clear guidelines and explicit communication) Cancellation policy: 24 hours notice for cancellations is required or you will be billed for the session. Emergencies are exceptions. Please check each of the boxes to demonstrate your understanding of the following guidelines around our work together

Consent Type your full legal name into the box below to indicate that you have read this document thoroughly and recognize that you have the opportunity to ask questions, guide your experience, and change your mind about what you would like to receive and how.