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PURE DEVOTION CONSULT

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Question 1 of 20

Phone Number:

Question 2 of 20

Location/Time Zone:

Question 3 of 20

DOB:

Question 4 of 20

Gender Identity:

Question 5 of 20

Relationship Status:

Question 6 of 20

Relationship Preference:

Question 7 of 20

What is the state of your overall health?

Question 8 of 20

What is a telltale sign that your body is under tension?

Question 9 of 20

What is your most familiar way to manage tension?

Question 10 of 20

On a scale of 1-10 (1 being the lowest and 10 being the highest), how satisfied are you with your current sexual experiences?

Question 11 of 20

What area of your sexuality do you enjoy the most?

Question 12 of 20

In a concise paragraph, describe the biggest concern or sexual roadblock you are struggling with?

Question 13 of 20

How do you feel about this road block and how it is affecting your life?

Question 14 of 20

Describe any destructive behaviors you engage in to lessen the pain around this roadblock?

Question 15 of 20

What is the biggest obstacle preventing you from living a fulfilling life/sex life right now?

Question 16 of 20

Briefly highlight any areas of your life that are thriving?

Question 17 of 20

What is your current knowledge of Tantra? Have you studied with anyone else? If so, when?

Question 18 of 20

Are you willing to integrate a regular meditation practice into your life?

Question 19 of 20

Which of these desired results apply to you the most (check all that apply):

(Select all that apply)
A

Healing Past Wounds

B

Knowing Yourself

C

Embodying Confidence

D

Intimate Power/Intelligence

E

Connection With Partner

F

Enhancing Pleasure Skills

G

Living in Your Authentic Sexual Nature

H

Becoming a Better Lover/Sexual Mastery

I

Using Sex as Medicine

J

Other

Question 20 of 20

What do you think would make you an ideal client for Theano?

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