Contact Form for Session with Devi Jean Bliss

1. Full Name:
2. Date of Birth:
3. City:
4. Province or State:
5. Email:
6. Best Telephone Contact Number (mandatory):

• When is the best time for me to contact you?
• May I leave a voicemail message?
• How did you discover me?
• Are you thoroughly familiar with my website?

• What type of session are you interested in?

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

• Are you currently involved in an intimate relationship(s)?  How is it working out?

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

• 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?