Name

Email Address

Please let us know what you feel is important and relevant to share about your relationship history - including intimacy patterns, joys and challenges, along with your intentions for experiencing "Divine Union For Lovers."

Please share about any specific challenges either of you have experienced with feeling safety, receiving touch, feeling arousal & pleasure, or obstacles in lovemaking that you would like to resolve:

Please share about your current lifestyle and self-care practices?

Who were you referred by or how did you discover Divine Union For Lovers?

Is there anything else you would like to share or questions you would like to ask?

Please provide several days and times you are available for a complementary discovery call and the best number to reach you:

Informed Consent & Agreements Informed Consent & Agreements I understand that Somatic Sexual Wholeness involves a complementary series of health and wellness modalities designed to expand my understanding and experience of embodied sexual health, wholeness, and well being. I understand that all touch during the session will be given only by my permission and is intended for the relaxation of my nervous system, awakening my body’s energy channels, and releasing any stored contractions. I understand that during all parts of all sessions, the facilitator will remain fully clothed at all times and all touch will be uni-directional from facilitator to client. I understand that Somatic Sexual Wholeness practitioners do not act as surrogate partners. I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation in the session, and I will update practitioners on any changes in my health status. I understand that Somatic Sexual Wholeness is not psychotherapy or medical treatment. I will consult my medical doctor if I have any question about my physical or mental health. Printing my name below confirms I have read, understand and agree to the above statements.

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