Name

First Name

Last Name

Pronouns

Confirm email

How did you hear about us?

How you are interested in being supported.

1:1 with Amanda (and you are a woman of any orientation or a queer identified individual)

2:2 with Amanda and Tom (and you are a couple of any gender, orientation and relationship structure)

If you interested in a 2:2 container as a couple, please share your partner's name. Both of you must submit this form before we schedule, no exceptions.

On the Welcome page, which of the "You..." statements do you resonate with the most? Feel free to paraphrase.

Why are you interested in our offering?

What do you most want in your life right now in the realms of s3x, love and intimacy?

Please share about any current practices, joys or activities that resource you.

Have you experienced or been treated for severe psychological trauma, abuse of any kind or psychosis? If yes, please specify.

While not necessary, please share if you have any experience in a supportive container centering intimacy, embodiment, or something related, whether 1:1, 2:1, 2:2 or in a group?

We are currently booking in the Pacific Northwest (the Columbia River Gorge), and Upstate New York (Rochester, NY) for spring and summer 2025. Which location works best for you? If you wish us to travel to you, (with travel expenses paid), please indicate "Other."

Pacific Northwest

Rochester, NY

Other

Do you have any limitations or disabilities we should know about?

Our offering is an in-depth immersive experience that requires an investment of time, money and energy. Do you have the resources in your life right now to support you should you decide to move forward?

Is there anything else you'd like us to know about you?

Please let us know your general availability and time zone below. We will get back to you within 3-5 days to schedule a complimentary 30 minute Zoom call.

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