Tantra Questionnaire

Those interested in Tantra Instruction are asked to fill out the following brief questionnaire prior to scheduling a phone consultation with Melissa. Please answer the questions as completely as possible with detailed information. Be assured that your information is strictly confidential and will be viewed only by Melissa. If you don’t receive a response within two business days, please send an email to contact@yourgoddesscoach.com

Sessions are held in New York City, by phone, and via Skype for international clients.

Your Email:

Please Confirm Your Email:

First Name:

Last Name:

Daytime Phone:

Evening Phone:

Location and time zone:

What is your Gender

Disclaimer:

Melissa may utilize some or all of the following modalities in a session with you (the participant): dialogue, breathwork, intuitive readings, neurolinguistics, body awareness exercises, dance, and guided visualization. Participants are fully clothed throughout the session. The participant agrees and understands that the techniques are taught with respect and integrity, and the participant must also participate in the session in a respectful manner. Melissa does not support any sexual/romantic connection between practitioner and client, as appropriate boundaries are essential for growth and healing.

Check the sessions you are interested in:

Tantra Instruction for Individuals Tantra Instruction for Couples Semi-Private Tantra Classes (2-8 people)

What challenges are you experiencing that are attracting you to tantra?

On a scale of 1 to 10, how comfortable are you with your sexuality? Explain.

What is your relationship status (inactive, dating, committed relationship) and level of satisfaction with your current situation.

Describe your previous experience with tantra-books, courses, private sessions.

Have you ever worked with a coach or therapist? If so, please describe, and indicate whether you are currently working with someone.

How did you hear about www.YourGoddessCoach.com?

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