Toloache Application

Thank you for your interest in toloache! For the month of June, we have a special promo.

*For the month of June, sessions will be discounted at $75 each. All sessions are virtual for now.

This application is the first step toward expressing interest. Once I receive your responses, we will set up a free call to make sure we’re a good fit.

Name

First Name

Last Name

Phone

(###)

###

####

Pronouns

examples: he/him, she/her, they/them

What are you seeking support with? What are the main things you'd like to work with during our time together?

What comes to mind when you think of a peaceful place? For example, somewhere in nature, near water, a mountain, what is your element?

What are your current greatest challenges or obstacles when it comes to meeting your goals?

What is your previous experience with therapy/coaching/personal development/breathwork/hyposis?

What symbolizes the highest good to you?

I will not diagnose conditions, prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. This work does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. Having read, completed and understood the foregoing, I request to receive Pleasure Ceremony's services. I understand that my practitioner is providing their time for me at my request, and is not responsible for the outcome of the session. I agree to hold the practitioner harmless for any intended or unintended result.

I agree