TANTRA FOR LIFE
Experience the moment

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BOOKING FORM
To book an appointment I require that the following form be submitted ensuring all fields are complete with as much information as possible. A paypal deposit is required immediately to hold your appt. You should receive a response within 48 hours including details of how to pay the deposit.
EMAIL ADDRESS:
FULL NAME:
CONTACT PHONE NUMBER:
SESSION YOU ARE BOOKING? MENS 2 hr-$600
MENS 3 hr-$800
MENS 4 hr-$1000
MENS 8 hr-$1600
WOMENS 3 hr-$400
WOMENS 4 hr-$500
WOMENS 8 hr-$800
COUPLES 3 hr-$900
COUPLES 4 hr-$1100
COUPLES 8 hr-$1800
SESSION DATE, IF POSSIBLE LIST OPTIONS:
SESSION START TIME Early morning
Morning
Noon
Afternoon
Early evening
SESSION LOCATION: Atlanta
Boston/Worcester, MA
Chicago
New York
Phoenix
Toronto
Washington DC
Other (List below)
OTHER CITY, IF NOT LISTED ABOVE:
INCALL OR OUTCALL: Incall
Outcall
IF OUTCALL, SESSION ADDRESS:
AGE: Under 21
21-30
31-40
41-50
51-60
Over 60
OCCUPATION/COMPANY:
WHAT DO YOU KNOW ABOUT TANTRA AND YOUR REASONS FOR PURSUING IT:
INTENTION/S FOR YOUR SESSION TIME, WHAT WOULD YOU LIKE TO DO/COVER/LEARN/EXPERIENCE:
TANTRA GODS/GODDESSES YOU HAVE SEEN (enter NONE if you haven't):
DO YOU HAVE EXPERIENCE WITH THE FOLLOWING: Workout regularly for Fitness
Meditation
Martial Arts
Yoga
Massage (Therapeutic)
None of the above
MEDICAL HISTORY (See below also) Depression
Diabetes
Hypertension
Medication/s
Sexual Dysfunction
STD's
Allergies
Other
None
IF YOU TICKED ONE OR MORE OF THE ABOVE OTHER THAN NONE, PLEASE GIVE DETAILS
ANYTHING ELSE THAT YOU WISH TO SHARE:
AND FINALLY, WHY DO YOU WISH TO HAVE A SESSION WITH ME?
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