Contact

Please fill out this form to get in touch, and I’ll respond personally via email to complete the screening process and confirm the details for our time together. If you prefer email to forms, you may email me at hello @ embodyempower . com (removing spaces), making sure to include all the same information that’s in the form.

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Name *

Email *

Phone

Proposed Date and Time *

Date

Time

Notes on availability

You may propose additional times, or times that generally that work well for you, e.g. “weekdays during the afternoon”

Location *IncallOutcall

Outcall Location *

Note: Outcall visits may require an additional deposit fee to cover travel costs.

Type of Date *— Select —The Art of IntimacyThe Art of GivingThe Art of ReceivingThe Art of EmbodimentArrangements & Packages

Session Length *1 hour1.5 hours2 hours

Session Length *1.5 hours2 hours

Date Length *1.5 hours2 hours3 hours4 hours5+ hours (please indicate)OvernightFull DayWeekend GetawayA Week in Paradise

Arrangement type *Tantric Journey3 Overnights5 OvernightsThree 4h DatesFive 4h Dates3 Art of Embodiment Sessions3 Art of Giving Sessions3 Art of Recieving Sessions5 Art of Embodiment Sessions5 Art of Recieving Sessions5 Art of Giving Sessions

Screening Option *– Select –10 Minute Video Chat (requires $50 paid upfront)ReferencesLinkedIn or company website, and a selfiePhoto ID and a selfie

I will reach out to you with the instructions for the option you choose. We can do this step after confirming a time, but it is required to fully confirm the booking. Inquires submitted with screening will also be prioritized over ones without.

Please provide as much information as you can for at least one or preferably two providers with whom you’ve met before.

First reference: Name

First reference: Email

First reference: Phone

First reference: Website, twitter, or other site

Second Reference: Name

Second reference: Email

Second reference: Phone

Second reference: Website, twitter, or other site

Your LinkedIn or Company Website

Note: Your name and photo must be shown.

Your Photo ID

Click or drag a file to this area to upload.

Your Driver’s License, School ID, Passport, Employer ID, Driver’s license. You may cover or blur information other than your name and photo.

Selfie

Click or drag a file to this area to upload.

Please upload a recent selfie

Payment method *CashAppVenmoAmazon Gift CardBitcoin

Message *

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