Intake Form - Skype Coaching

Somatic Sex Education can include coaching in breath, movement, body awareness, boundary-setting, communication, anatomy, sensate focus, massage, and other body-based teaching about sex. Somatic Sex Education is designed to nurture, deepen or awaken the sensual self. Whether you want to heal feelings of sexual shame, explore the intersection of sex and spirit, better express your desires, or deepen erotic pleasure, I welcome you on this journey.

 

Please complete the form below

Name *
Name
Phone
Phone
Date of Birth
Date of Birth
Your intention(s) and goals will guide this work. I am here to support your deepest and highest intention(s) for yourself. Please consider and state your deepest intention(s) regarding sexuality, eros, spirituality and wellbeing. In addition, please write down any specific goals that you would like to accomplish during our work together. *
Sexual History and Information: (Please address only those questions that feel relevant. I assure professional confidentiality. If you want me to work together with your psychotherapist, medical doctor or other health practitioner, I will ask you to sign a release form.)
Bodywork: Somatic Sex Educators who are Sexological Bodyworkers are trained to do genital and anal touch, at the request of the student, and when deemed appropriate by the practitioner. Through this touch, we assist students in developing presence within the body, opening interior awareness, and learning how the body can become more and more alive. We offer experiential learning opportunities that consciously access profound ecstatic and erotic states. While direct bodywork is not possible over Skype, sessions can be tailored to guide students through their own self-exploration while being witnessed/observed by the educator. If you would like to include bodywork as part of your learning experience, please complete this section of the intake form:
Do you have any of the following conditions?
Pregnant
Osteoporosis
Inflammation
Heart Condition
Diabetes
Arthritis
Vein or Artery Condition
Breathing Problems
Pain
Epilepsy
Recent Surgery
Allergies
Genital Pain
Skin Condition
INFORMED CONSENT AND WAIVER Please read carefully. By checking each box, you are acknowledging and agreeing to these terms.
Somatic Sex Education/Sexuality Coaching is not psychotherapy or medical treatment.
I have stated all medical conditions that I am aware of, and I will update Monica on any changes in my health status.
I understand that any activity during the session is fully optional, and only done with my consent. I agree to communicate my needs as they arise, including stopping any exercise at any moment, should it become uncomfortable for me.
Monica does not act as a surrogate partner. She remains clothed during sessions. She will not become romantically or sexually involved with a client. I understand that these sessions are about me, my own internal experience, and intended to deepen my relationship with myself.
Client arousal may take place during sessions. I understand that my arousal is to be held as a subjective experience and not projected onto the client/practitioner relationship. Any words/actions that attempt to sexualize the practitioner and non-consensually involve the practitioner in one's fantasy is a violation of boundaries and will result in termination of sessions.
There are some client cases in which psychotherapy may be recommended alongside or instead of somatic sex education. Sometimes this is only determined once our work has already begun. I understand that somatic sex education my not be the right modality for me at this time, and that Monica has the right to terminate sessions if she feels that my needs are beyond her scope of practice.
All Skype sessions must be booked and paid for a minimum of 48-hours in advance. Failure to make online payment 48-hours in advance will result in loss of my appointment time.
Cancellation Policy: Sessions cancelled within 24 to 48 hours will receive a 50% refund. Sessions cancelled less than 24 hours in advance are non-refundable.
Rescheduling Policy: Session can be rescheduled when given 24 - 48 hours notice. The session must be rescheduled within 2 weeks of the original date, and can only be rescheduled once.
By signing this release, I hereby waive Monica of any and all liability, past, present or future, relating to Somatic Sex Education, bodywork and coaching.