Inquiry Form Please fill out the contact form according to your comfort level. Those questions starred are necessary. Calendar Contact Me Here Name Phone Email Address Date Occupation Hobbies and Passions Best Time to Reach You Is it OK to Leave a Message? Is it OK to Leave a Message? YES NO Text Message? Text Message? YES NO Have you experienced Tantra or other forms of healing? Please explain. Including other practitioners you have seen. Have you looked over my website and offerings? Have you looked over my website and offerings? YES NO Are there any issues or health concerns you would like to share with me? What type of session(s) are you interested in? Do you have a date and time or a few dates and times, that you are interested in possibly scheduling. (The more options that work for you the better for me to create ease in scheduling) Are you aware of my 24 hour cancellation policy? Are you aware of my 24 hour cancellation policy? YES NO Are you aware of my deposit policy? Are you aware of my deposit policy? YES NO Are you aware of my painless screening policy? Are you aware of my painless screening policy? YES NO If you were to choose the best 3 words to describe what you are wanting to create for your life thru a session with me what would they be? Would you like to receive my newsletter? Would you like to receive my newsletter? YES NO Anything else you would like to add here? 1 + 15 = Submit