First Name *

Last Name *

Email *

Phone Number (optional)

Preferred Session Format *
In-Person (Union Square, NYC)Virtual (Phone or Zoom)

🌿 About You

What inspired you to apply for coaching at this time? *

What areas are you currently working through or seeking support in? *
Intimacy & RelationshipsSelf-Love & ConfidenceEmotional HealingSexual Energy ActivationEnergy Alignment & EmbodimentOther

Have you worked with a coach or therapist before? *
YesNo

If yes, what worked or didn’t?

Do you have any previous experience with Tantra, energy work, or somatic healing?

🔥 Your Readiness

Are you ready to commit to a transformational process that includes both energetic work and hands-on TaoTantra healing? *
Yes, I’m readyI’m open but curiousI have questions

What kind of support are you looking for in this container?

Are you interested in a specific package?
5-session: Awaken10-session: Align12–15 session: DeepenNot sure yet

Do you have any health or energetic concerns I should be aware of before we begin?

💌 Final Notes

How did you hear about this work?

Is there anything else you’d like me to know before we connect?