Womb Steam Client Consultation Form

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Hi, my name is Hājar - I am a full spectrum afro-traditional doula and certified womb steam practitioner. You can find me on Twitter @yungmedusa or on my website www.yungmedusa.com.

Thank you for considering me to craft a vaginal steam for you!

These responses will not be shared with ANYONE. Your honesty is essential to keeping this process safe. There's no shame here - only solutions!

PLEASE BE AWARE, YOU ARE NOT ELIGIBLE FOR A WOMB STEAM IF YOU DON'T KNOW HOW LONG YOUR MENSTRUAL CYCLE IS. This is for your safety!

After you complete your form, we'll schedule a face-to-face (via Zoom or in-person) or phone consultation to clarify, ask questions, and tie up any loose ends. This part is important to make sure that we're on the same page and to clear up any uncertainty.

Please do not pay until AFTER your consultation!

Payment can be sent via:

Paypal: yvngmedvsa

Cashapp: $yvngmedvsa

Venmo: yvngmedvsa

Email *

What is your preferred name? *

What are your pronouns? *

Have you ever done a womb steam before? *

Yes

Yes, at a Goddess/Yoni Steam Party

Why are you interested in a womb steam? Check all that apply. *

I want to take control of my womb health

I'm looking for new self care rituals

For cord-cutting

I'm having a womb issue (Specify below)

Required

If you checked off "I'm having a womb issue," please specify:

Do you have any allergies? *

Yes

If you answered "Yes" to the previous question, what allergies do you have?

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