Questionnaire

Name*  

Email Address*  

Birth Year*  
Phone #

Are there any reoccurring challenges that you would like to address during your session?  

Physical/Sexual Health:  
Do you have any health issues or have you had in the past?  

Is there a sexual or emotional abuse history in your childhood or 
family? If so please give a brief description.  

Are you presently in a relationship?  

If you are in a relationship are you happy with your feelings of connection, intimacy levels and/or sexual relations?  

If you are in a relationship, is your partner open to Tantra?  

Briefly describe your relationship with your family.

Have you ever experienced a full body orgasm?  

Have you ever had an orgasm without ejaculating?  

As an intention, what would you like to have more of in your life?  

As an intention, what would you like to release from your life?

What is your desired outcome from our meeting?

Have you seen a Tantra practitioner or Psych-K Pro in the past? If so, how was your experience?  

Is there anything that I did not ask that you would like to share or add?  

Thank you for sharing yourself with me . I look forward to being a part of your journey!

lMany Blessings........Please:

Arrive on time

Open to your journey

Freshly showered

12 - Hour cancellation policy ( deposit required on first visit, next day)
Please no alcohol or drugs, as it will detract from your total experience.
There is no sexual contact with me, this is all about you!

Love and Light,
Tara    taralotustemple@gmail.com