R&R Tantra Intimate Remedies
Tantra Sessions, Holistic Teaching of Mind* Body*Energies*Innerself* Sacred Sex Coaching
Client Intake Form Private Sessions

If you would take a moment to fill out the Client Intake form that would be very helpful.

In order to book session we will need this info.  

Click on the link below 



                                                                                                                 Link to Form

Instructions for Registration
When registering for one or more of R&R Tantra Intimate Remedies activities,
   please follow the instructions below to be sure you get registered properly.

   If you are attending and R&R Tantra Intimate Remedies Workshop, Private Sessions or Seminars and an overnight stay is needed, no need to worry lodging will be provided by us.
 *Please note Meals, Drinks & Room Service are not included

  *Please note our locations of our Workshops and Events vary so it is very important that you provide us with a current email and or a phone number in order to get directions. We provide Workshops and Events all over the United States so this information is very important.

 *Step 1*  Please email Info@rnrtantra.com with your Name and Contact Info, along with the Event or Events you would like to attend so we can be sure to reserve a spot for you. Please include the location of the Event and the number of people attending. 

 *Step 2*   Please fill this form out and you can choose to send the form back by either email or by US mail to R&R Tantra Intimate Remedies when complete. Each person attending will need to fill out a Registration Form.

   R&R Tantra Intimate Remedies offer a few options for payment:

 1. Pay in full when returning your Registration Forms

 2. Pay 50% of the total cost when returning you Registration Forms.
(The remaining balance will be due
7 days prior to your event date)

    *Refund Policy*

Please be sure you want to attend before registering.
Refund policy is strictly adhered to

   *no refunds on the day of the event
or 7 days prior to the event*

*Cancellation Fees*

   60 days 25% of price
   30-59 days 35% of price
   7-29 days 50% of price
Registration Form
                       R & R Tantra Intimate Remedies
           Enrollment Registration Application

Please complete the following registration application before attending any R & R
Tantra Intimate Remedies programs, events, workshops, seminars, private
sessions.  If you’re a couple please complete a separate form for each of you.  We have groups for all relationship structures, styles and sexual orientations.

First Name _________________ Last Name ___________________

I am:    
___ male     
___ female    
___ couple   
___ single    
___ married     
___ in a relationship but attending as a single     

if you're in a relationship, how long have you been together?

___ in a committed relationship     ___ years,                ___ months
* Birth date: Month ________ Day ________ Year ______

Email _________________________________

Cell Phone: (____)_______________________

Occupation _______________________________________

______ I verify that I am at least 21 years of age*

Birth Date ___/___/________

*(You must be 21 or older. Positive ID showing proof of age is required).

I am (pick the ones that best describe you):

___ Bi-Curious     
___ Heterosexual     
___ Bisexual     
___ Lesbian        
___ Straight
___ Swinger
___ Monogamous     
___ Gay     
___ Transgendered
___ Transvestite    
___ Other (Please describe)     

1. Describe yourself - your qualities, traits, characteristics and

2. What would you like? (If more than one apply, number in order of
_____ celibacy
_____ committed, exclusive, living together, primary relationship, one to one
_____ committed, exclusive, living together, primary relationship
_____ committed relationship
_____ fetish (please describe _______________________)
_____ living alone
_____ marriage
_____ monogamy (married to one person)
_____ open relationship
_____ open marriage (married to one person, dating outside of marriage)
_____ single and dating (one person at a time)
_____ single and dating (more than one person at a time)
_____ swinging/lifestyles (sexual episodes)
_____ tantra/tantric (sacred sexuality)
_____ other (please explain) _________________________

3. Do you have any experience with tantra? If so, please describe

3A.  Describe your first experience with masturbation.

3B.  Describe your first experience with orgasm.

3C.  Describe your first experience having sex with another person.

3D.  Describe your first experience with intercourse.

4. What is your current relationship status?

5. Are you happy? To what degree?

6. If you’re not happy, what do you seek?

7. Are you and your partner(s) sexually active? ______________________

If not, is there a reason? Please explain. ____________________________

8. What are your attitudes toward nudity?

9. What are your attitudes towards sexual behavior, orientations or
relationship structures that are different than yours?

10. Describe your boundaries and limitations around sexual interactions with people
you just meet ( like for instance the people who attend the workshops ) ie. can you
speak openly?, can you take part in group activities?

11. Do you have children? ____ If so, how many? ______ Are they grown? _____

Do they live with you? _____

12. Do you want children _____ If so, how many children do you want?______

13. If you were raised by a single parent, how did that affect you?

14. Describe two critical events in your growing up that affect you to this
_________________________________________________ ____________

15. What was the cumulative effect of your childhood on who you are now?
__________________________________________________ ___________

16. Describe two peak events from your past that affect you to this day?
___________________________________________________ __________

17. Describe your physical appearance. Attach photos, several if possible, to
show your many moods.
_________________________________________________ ____________

18. Height ____________ Weight _____________ Body Type ____________

19. What else would you like to tell us about your physical self:

20. Do you have any physical challenges and if so, do you need any special
considerations for these challenges?
_________________________________________________ _____________

21. Describe your Personality:

22. What are your best qualities?

23. What are your faults?

24. What are your interests (sexually)?

25. Describe your boundaries(sexually):

26. Describe your limitations (sexually):

27. Describe your expectations (sexually):

28. Describe your desires (sexually):

29. Describe your fantasies (sexually):

30. Do you have any fetishes? If so, please describe
___________________________________________________________ ____

31. What do you seek in relationship?
__________________________________________ _____________________

32. Describe their personality:

33. What are the qualities of your ideal mate?

34. Describe your current sexual or intimate relationships:
_________________________________________________ _______________

35. Please tell us anything else about yourself that you think would be
relevant for us to know:
_____________________________________________ ___________________

36. What attracts you to the R & R Tantra Intimate Remedies events and
_______________________________________________ _________________

I’m interested in: Events, workshops, seminars or groups that meet:

___ Morning ____ Afternoon ___ Evening
___ All Day Workshops
___ Two Day Events
___ Overnight Private Sessions
___ Counseling/Coaching/Therapy
___ Private Sessions
Please allow R & R Tantra Intimate Remedies sufficient time to go over your
registration and get in contact with you if necessary.
Check or money order accepted. Check must be received at least one week prior
to the event you’re attending so it may clear the bank. You will be provided with
the address in which to mail this form.

Date/Time I want my appointment _________________ AM/PM 
Payment in full required before admission service, group, class or function.

R & R Tantra Intimate Remedies,