First Name *

Last Name

Date of birth *

Email

Phone *

Social media *

ID & Selfie *

Please upload current ID with a selfie to confirm it is you

Line of work *

Do you have experience with Tantric body work? *

Yes

No

I need a call to tell me more about Tantra before booking *

Yes

No

Do any of the following apply to you

Stress
Anxiety
Body pain/tension
Recent injury/surgeries
Heart problems
On medications
Prone to dizziness or headaches
Light sensitivity
Smell sensitivity
Touch sensitivity
Other-please elaborate bellow
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If other sensitivities, please explain bellow

Check off bellow

Hot stones

Hot towels

Massage table

Bed

Pressure level

Light

Medium

Strong

Oil or lotion preference

Oil

Lotion

None

Preferred areas

Head/face/neck

Back

Legs/glutes/feet

Arms/hands

What would you like to work on during your session

How did you hear about us? *

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If other please describe bellow

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