Questionnaire for Liberate Pleasure Breakthrough & Expansion Session

 I look forward to connecting & supporting you!!  
All of your answers to the questions below are confidential.
Thanks for taking the time to complete this form. 
Your answers help me to serve you better during your session and allow you to get the most out of your  session & investment of time.

Connecting women & their partners to more pleasure, orgasm & ecstasy,

Vireo
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Email *
Full name (first & last) *
What is your complete mailing address? Where are you located?
What is your name on Facebook? *
What is your cell phone number and/or landline? (please indicate if it is cell/landline) *
How old/young are you?
Clear selection
What is your relationship status (check as many as apply)? *
Required
What are you yearning for in the area of liberation & pleasure? What do you want in the area of your sacred femininity, sacred masculinity and sacred sexuality? *
What is your life vision / goal / dream that you have? *
What holds you back? What are your biggest challenges/biggest struggles/ biggest obstacles, regarding pleasure (sexuality,  masculinity, femininity)? *
How often are you experiencing solo sex (masturbation, self pleasuring) on average?
Clear selection
On a scale of 1 to 10, how satisfied are you with your self pleasuring.
not at all
totally satisfied
Clear selection
Tell me more about why you chose this rating.
IF you are having sex with another, how often are you having sex (on average)?
Clear selection
On a sale of 1 to 10, how satisfied are you with your sex life (partner sex)?
Not at all
Totally satisfied
Clear selection
What is 1 limiting belief you would like to transform around your sexuality? *
What’s your biggest reason for booking your Liberate Pleasure Breakthrough Session with me, Vireo? *
On a scale of 1-10, where 1 is 'not at all' and 10 is 'completely', how committed are you to doing whatever it takes to increase and liberate pleasure in your life now? *
Not at all
Completely, I am all in.
On a scale of 1-10, how open are you to receiving support and being coached around liberating your pleasure? *
Not at all
I am all in.
On a scale of 1-10, how able are you to invest time, money and energy into liberating your pleasure? *
Not at all.
I am all in.
Please remind me where & when we met or how you found me (who referred me)....
Anything else that you want me to know before we meet on zoom for your session?
A copy of your responses will be emailed to the address you provided.
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