To request a session with Devi Bliss, please complete and submit the form below. It is vital to approach this work with reverence and intention as it is indeed a sacred interaction. 
So, ask yourself: Why are you coming to me? What do you hope to learn and experience?
My heartfelt mission is to liberate you from personal stress and suffering and initiate you into the divine realm of tantric bliss.
Namaste
Dakini Devi Bliss

This form and all information are held in the strictest confidence.
No information on this form will ever be shared with anyone for any reason.

Client Information


Full Name




Date of Birth
(Please note that I only accept clients over the age of 25.)



City:



Province or State:



Email Address:



Do you wish to be added to our newsletter?

YesNo

Best Telephone Contact Number (mandatory)

When is the best time for me to contact you?

May I leave a voicemail message?

YesNo

How did you discover me?

Are you thoroughly familiar with my website?

YesNo

What type of session are you interested in?

1-hour Sensual Massage Session...$22090-minute Introductory Tantric Massage Session...$30090-minute Dark Tantra Massage or Bondassage® session...$3202-hour Tantric Goddess Worship Session...$4002-hour Tantric Couples Session...$500Half-Day Yoga Tantric Bliss Retreat...$600

Note: The 90-minute Introductory Session ($300) is highly recommended for new clients.


Have you visited any tantric practitioners before?
If so, who are they?



Are you currently involved in any intimate relationship(s)?

YesNo

How is it working out?

Are you willing to accept full responsibility for your health, well being, and personal pleasure?

YesNo

What previous experience have you had with Tantra, Yoga and/or Meditation?



Do you currently have any contagious illnesses; i.e., HIV, STDs or chronic skin disorders?
If so, what are they and what treatment have you received for them?



Do you have any current physical concerns and/or medical issues?
If so, what are they?

What prescription medications, if any, are you currently taking?

Do you have any diagnosed mental health issues?
If so, are you receiving treatment for your condition?



What are your three main reasons for seeking a tantric session with me?
Please list them in order of priority.



What would you like to specifically address in the areas of relationship intimacy and sexual healing?



Are you a childhood sexual abuse survivor, rape victim or PTSD sufferer?
If so, have you ever received professional therapy for your condition?



This form and all information are kept in strict confidence. No information will ever be shared from this form. All fields are required.

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Note:  Your privacy is my chief priority. I  will always respect it and I expect that you respect mine in return by adhering to my NO review policy. I approach each session with integrity and discretion and have always been blessed to meet those who value these same qualities.