R&R Tantra Intimate Remedies provided by Bravenet.com

Private Sessions Client Intake Form

Please fill this form out and submit it for Private sessions

CLIENT INTAKE FORM

Name:_____________________

Email:______________________

Phone (Optional):___________________

Age: __________

How did you hear about us?

What interests you in Tantra?

Have you ever had a Tantra Session?

If yes, please give a brief description

Have you read our information on our website?

Do you understand the difference between The Yoni, The Lingam,

The Sacred Spot Prostate?

If yes, which session are you interested in?

If you checked off the Sacred Spot Prostate, have you experienced

"Anal Play" of any kind?

PLEASE NOTE- The reason we ask the question is because you will need to be comfortable with the idea of having a finger inside your rectum.

Please look at the list below and check all that apply,

give an explanation if you feel comfortable

~~Premature Ejaculation___

~~Ejaculation Control___

~~Impotence___

~~Trouble Focusing____

~~1st Time looking for New Experience____

~~Learn to separate Orgasm from Ejaculation___

In your own words, please explain any issues you would like to

address during your session?

Preferred day for session?

Monday___

Tuesday___

Wednesday___

Thursday___

Friday___

Saturday___

Sunday(prebooked only)

How soon would you like to start your session?

Would you be interested in regularly scheduled sessions?

Thank you so much and if there is something I have left

out that you want me to know, please use this box to let me know..

Thank you so much for taking the time to complete this form. Again this is a very serious experience in your life & we want to make sure you are completely understanding of our Tantra Holistic Teachings.

Please DO NOT submit it just copy and paste the entire page to me and email it randrspa@gmail.com

Instructions for Registration

*Registration*

   When registering for one or more of R&R Tantra Intimate Remedies activities,
   please follow the instructions below to be sure you get registered properly.

   If you are attending and R&R Tantra Intimate Remedies Workshop, Private Sessions or Seminars and an overnight stay is needed, no need to worry lodging will be provided by us.
*Please note Meals, Drinks & Room Service are not included

*Please note our locations of our Workshops and Events vary so it is very important that you provide us with a current email and or a phone number in order to get directions. We provide Workshops and Events all over the United States so this information is very important.

*Step 1* Please email randrspa@gmail.com with your Name and Contact Info, along with the Event or Events you would like to attend so we can be sure to reserve a spot for you. Please include the location of the Event and the number of people attending.

*Step 2*   Please fill this form out and you can choose to send the form back by either email or by US mail to R&R Tantra Intimate Remedies when complete. Each person attending will need to fill out a Registration Form.

   R&R Tantra Intimate Remedies offer a few options for payment:

1. Pay in full when returning your Registration Forms

2. Pay 50% of the total cost when returning you Registration Forms.
(The remaining balance will be due
7 days prior to your event date)

*Refund Policy*

Please be sure you want to attend before registering.
Refund policy is strictly adhered to
   *no refunds on the day of the event
or 7 days prior to the event*

*Cancellation Fees*

   60 days 25% of price
   30-59 days 35% of price
   7-29 days 50% of price

Registration Form

                     R & R Tantra Intimate Remedies
           Enrollment Registration Application

Please complete the following registration application before attending any R & R
Tantra Intimate Remedies programs, events, workshops, seminars, private
sessions. If you’re a couple please complete a separate form for each of you. We have groups for all relationship structures, styles and sexual orientations.

First Name _________________ Last Name ___________________

I am:
___ male
___ female
___ couple
___ single
___ married
___ in a relationship but attending as a single

if you're in a relationship, how long have you been together?

___ in a committed relationship    ___ years,                ___ months

* Birth date: Month ________ Day ________ Year ______

Email _________________________________

Cell Phone: (____)_______________________

Occupation _______________________________________

______ I verify that I am at least 21 years of age*

Birth Date ___/___/________

*(You must be 21 or older. Positive ID showing proof of age is required).

I am (pick the ones that best describe you):

___ Bi-Curious
___ Heterosexual
___ Bisexual
___ Lesbian
___ Straight
___ Swinger
___ Monogamous
___ Gay
___ Transgendered
___ Transvestite
___ Other (Please describe)

1. Describe yourself - your qualities, traits, characteristics and
challenges.
________________________________________________________

2. What would you like? (If more than one apply, number in order of
preference).
_____ celibacy
_____ committed, exclusive, living together, primary relationship, one to one
_____ committed, exclusive, living together, primary relationship
_____ committed relationship
_____ fetish (please describe _______________________)
_____ living alone
_____ marriage
_____ monogamy (married to one person)
_____ open relationship
_____ open marriage (married to one person, dating outside of marriage)
_____ single and dating (one person at a time)
_____ single and dating (more than one person at a time)
_____ swinging/lifestyles (sexual episodes)
_____ tantra/tantric (sacred sexuality)
_____ other (please explain) _________________________

3. Do you have any experience with tantra? If so, please describe
___________________________________________________________

3A. Describe your first experience with masturbation.
___________________________________________________________

3B. Describe your first experience with orgasm.
___________________________________________________________

3C. Describe your first experience having sex with another person.
____________________________________________________________

3D. Describe your first experience with intercourse.
____________________________________________________________

4. What is your current relationship status?
____________________________________________________________

5. Are you happy? To what degree?
____________________________________________________________

6. If you’re not happy, what do you seek?
____________________________________________________________

7. Are you and your partner(s) sexually active? ______________________

If not, is there a reason? Please explain. ____________________________

8. What are your attitudes toward nudity?
_____________________________________________________________

9. What are your attitudes towards sexual behavior, orientations or
relationship structures that are different than yours?
_____________________________________________________________

10. Describe your boundaries and limitations around sexual interactions with people
you just meet ( like for instance the people who attend the workshops ) ie. can you
speak openly?, can you take part in group activities?
_____________________________________________________________

11. Do you have children? ____ If so, how many? ______ Are they grown? _____

Do they live with you? _____

12. Do you want children _____ If so, how many children do you want?______

13. If you were raised by a single parent, how did that affect you?
_____________________________________________________________

14. Describe two critical events in your growing up that affect you to this
day.
_________________________________________________ ____________

15. What was the cumulative effect of your childhood on who you are now?
__________________________________________________ ___________

16. Describe two peak events from your past that affect you to this day?
___________________________________________________ __________

17. Describe your physical appearance. Attach photos, several if possible, to
show your many moods.
_________________________________________________ ____________

18. Height ____________ Weight _____________ Body Type ____________

19. What else would you like to tell us about your physical self:
______________________________________________________________

20. Do you have any physical challenges and if so, do you need any special
considerations for these challenges?
_________________________________________________ _____________

21. Describe your Personality:
_______________________________________________________________

22. What are your best qualities?
_______________________________________________________________

23. What are your faults?
_______________________________________________________________

24. What are your interests (sexually)?
_______________________________________________________________

25. Describe your boundaries(sexually):
_______________________________________________________________

26. Describe your limitations (sexually):
_______________________________________________________________

27. Describe your expectations (sexually):
_______________________________________________________________

28. Describe your desires (sexually):
_______________________________________________________________

29. Describe your fantasies (sexually):
_______________________________________________________________

30. Do you have any fetishes? If so, please describe
___________________________________________________________ ____

31. What do you seek in relationship?
__________________________________________ _____________________

32. Describe their personality:
________________________________________________________________

33. What are the qualities of your ideal mate?
________________________________________________________________

34. Describe your current sexual or intimate relationships:
_________________________________________________ _______________

35. Please tell us anything else about yourself that you think would be
relevant for us to know:
_____________________________________________ ___________________

36. What attracts you to the R & R Tantra Intimate Remedies events and
classes?
_______________________________________________ _________________

I’m interested in: Events, workshops, seminars or groups that meet:

___ Morning ____ Afternoon ___ Evening
___ All Day Workshops
___ Two Day Events
___ Overnight Private Sessions
___ Counseling/Coaching/Therapy
___ Private Sessions

Please allow R & R Tantra Intimate Remedies sufficient time to go over your
registration and get in contact with you if necessary.
Check or money order accepted. Check must be received at least one week prior
to the event you’re attending so it may clear the bank. You will be provided with
the address in which to mail this form.

Date/Time I want my appointment _________________ AM/PM

Payment in full required before admission service, group, class or function.

R & R Tantra Intimate Remedies,