Intake Application Form

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Once I have reviewed your Intake Application form I will send you a link to a google calendar with my current available appointment times. I typically book sessions one to four (1 to 4) weeks in advance. Our first session will be two (2) hours long. Future sessions will be a minimum of two (2) hours up to four (4) hours. Special requests for longer sessions can be arranged once we have worked together for multiple sessions if the need arises.

Name (First and Last)
*

Phone number *

Email *

Address *

How did you hear about my practice? *

Do you have previous experience receiving erotic bodywork? *

Do you have previous BDSM experience? *

Please share more about your previous erotic bodywork and/or BDSM experience? *

If this is a new adventure for you, what you would like to explore? *

Together with coaching in breath, body awareness, boundary-setting, and communication, sessions can include the following embodiment activities. Check the ones that interest you the most. *

sensual massage

sensation play

impact play

full body erotic massage

guided meditations

sacred ritual

Required

Do you have a spiritual practice? Please describe. *

What is your relationship with substance use, chemical and plant medicine? *

Tell me about your current relationship to self pleasure and orgasm. *

Do you have any allergies and medical conditions? *

Difficult things from my sensual/sexual past or present that I want you to know are: *

Things I celebrate about my past or present in my journey with sensuality/sexuality and gender I want you to know: *

Please add anything else you would like me to know about your sexual history or current desire patterns, i.e. self-pleasuring patterns, fantasies, accessibility needs, or any other information you think is relevant.

My intention(s) for our time together is(are): *

SCREENING

Both security and privacy are important for us to establish a safe, open, and honest dialogue. I’m an entirely independent practitioner and it’s necessary for my safety and security to verify everyone with whom I may meet.

Before requesting an appointment, please be sure to review the following information.

My discreet and painless screening process is done through this form. Your privacy is very important to me. Any information given to me will be treated with the utmost confidentiality and respect.

I will email you within 5 days of receiving you completed Intake Application to arrange a time to talk.

You will need to email me (VioletTantra@gmail.com) a photo of your ID (driver's license, passport, NYC ID, etc.) and a photo of the ID next to your face before we book our first session. No Google Voice or burner numbers. I use these methods to confirm your identity and that you are over 21 years of age.

I CONSENT *

By selecting this button I understand that any information I share is private and confidential and will only be used for the purpose of assessment and welcoming me into my practice with Violet Moon.

Required

I UNDERSTAND *

All sessions are consent based and client lead. This means I will be empowered to choose my own adventure. We will create an agreement with intention, and I am responsible for stating my desires, limits, and boundaries before each session.

Required

I AGREE *

By selecting this button, I agree that I am an adult of legal age. This is a co-created experience and I am accountable and responsible for that which is in my domain. This includes understanding consent, my right to body autonomy, and agency, expressing my needs, wants, desires, limitations and boundaries.

Required

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