Pleasure on Purpose Application | Sextraordinary Living

Pleasure on Purpose Application Form

Welcome to The Pleasure on Purpose Healing System. This is your application and is your first step on your life changing journey with us.

Please be as detailed as possible when answering the questions below. Set aside at least one hour for filling out this application. The deeper you go in this, the faster your results. We understand that you may not remember everything and that is okay. Do your best. Your subconscious does remember and everything that needs to come out will present itself to us in your sessions.

Answering these questions will probably bring up some old memories and feelings that may be uncomfortable. This is all perfect and part of the process! Trust that these are exactly some of the things which are most likely holding you back and want to be deleted from your body memory. Make sure to take good care of yourself and consider filling out this application as your first "session" and the beginning of your sacred journey to wholeness.

ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL AND WILL NEVER BE SHARED WITH ANY THIRD PARTY.

You must fill out all required fields except for ones that do not apply to your gender. Either Heike or Jonathan will then have a phone call with you to go over your application and answer any questions prior to your first sessions.

First name

Last name

Phone

Birthday

Month

Day

Year

Birth City and Time

Emergency contact phone and relationship you

How did you hear about us?

What are you currently doing for a living, and what would you do if you could do ANYTHING? If You're already living your life's purpose, what would the next step be? Dream BIG.

What is your intention for these sessions? What is it you REALLY want out of life?

What are you currently doing on behalf of your intention? What have you already done?

What do you feel is keeping you from having what you want?

Please write 3-5 affirmations that if you believed on a deep, unconscious level, would allow you to have exactly what you're looking to get out of these sessions. Make it short and powerful. and make it in the present tense. Such as "I AM SAFE"

Are you currently in a relationship? For how long? How happy are you in it? Any previous relationships that have impacted you?

Do you have children? What's your relationship with them? Any miscarriages? Have you ever had an abortion?

Whats your relationship with your mother? With your father? Do you have siblings? How connected are you with them?

What was your childhood like? Did religion play a role in your upbringing?

Please describe the sexual education and messages you received about sexuality while growing up.

Please describe any key sexual experiences and how you feel those experiences affected you.

Wonderful or difficult things from my sexual/sensual HISTORY I want you to know are:

Wonderful or difficult things about my CURRENT sexuality/sensuality I want you to know are:

What is your masturbation practice like? Frequency? Duration? Method?

How often do you watch porn?

(Men Only) Have you experienced erectile dysfunction?

(Women Only) What is your experience with G-spot orgasm and/or female ejaculation?

If you have a partner, do they know you are receiving these sessions and are they supportive?

What word do you use to refer to your genitals during sex (i.e., yoni, vagina, pussy, kitty, penis, lingam, cock, etc.)

Do you have any STDs? If so, which ones? What are your feelings about them?

Have you experienced any kind of sexual abuse or trauma aside from anything mentioned above? If yes, please describe.

(Women Only) What was the date of your last period? The best times for a session are when you are ovulating and when you are on your period.

Are you currently on any type of medication? If so, for what?

Do you have ANY medical or other body pain we need to know about? These sessions can be physically intensive.

(Women Only) Do you have any scarring or pain inside your vagina from giving birth or anything else?

Pleasure on Purpose Application Form

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