Therapeutic Yoni Mapping Application Form

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Congratulations on taking the first step towards reconnecting to your sensuality and sexuality!

The purpose of this application is for me to get to know you better.

Therapeutic Yoni Mapping is a sacred experience that I honour deeply so if we are going to be on this journey together - we both have to have a full body yes to working with one another.

If we are a good fit, I will reach out to you via email to set up a connection call. If we are not quite aligned, I will do my best to find someone who could be and message you some options.

Thank you from the bottom of my heart for taking time to fill this application out. Your answers will not be shared with anyone and anything we ever discuss will stay between us.

First and Last Name *

Preferred Pronouns *

Email Address *

Phone Number *

Date of Birth *

YYYY

Where are you located? *

How did you find me and my services? *

Instagram

My Website

Word of Mouth

Yonilicious Referral

Other

What drew you to my work? Why do you feel that I may be the right person to hold space for you? *

Why are you looking into receiving a yoni mapping massage now? What are you hoping to learn or experience? *

Have you ever experienced a yoni mapping massage or do you have any experience working with medical professionals in regards to your own yoni? Please share as much as you are comfortable with. *

What is your current relationship with your body, pleasure and sex life? *

What personal development and healing modalities have you tried in the past? What has worked? What hasn't? *

Have you ever experienced physical trauma, surgery or scar tissue injuries in the yoni and your womb? If so, please tell me more. *

Are you pregnant or have you given birth within the last 3 months? *

Yes

Have you ever experienced any of the following... *

Abortion

Birth Trauma

Difficulty with Menstruation

Frequent UTI's

Hysterectomy (including the cervix)

Menopause

Painful Sex

PCOS

Sexual Trauma

STIs

Difficulty Experiencing Pleasure

Other

Required

Please list any known allergies or sensitivities (i.e. to food, essential oils, laundry detergents, pets, etc.) *

What support are you desiring in a therapeutic yoni mapping massage? *

Are you interested in building in Sex Coaching alongside your yoni mapping session? *

Yes

I am unsure if that is something that could be helpful, can you send more information?

No, I am not interested.

Do you feel in your body that you already have a full body yes to working together? *

Yes

I'm not sure what a 'yes' feels like in my body

Not just yet, a phone call would be helpful

Is there anything else you would like me to know about you before we explore next steps in the process? *

Submit

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