Embodied Man Retreat Consultation Form

Last name

First name *

Email Address *

Phone/Whatsapp *

Country - Location

Age

Please specify

What brings you here today?Select all that apply — or leave open if you are not sure yet.Life has been full and demanding — I am ready to slow down and come back to myselfI want to reconnect with my body, my presence, and my masculine powerI am carrying something — grief, disconnection, emotional weight — and I am ready to begin to release itI want to go deeper into my sexuality, intimacy, and erotic energyI sense there is a version of me waiting to emerge — and I want to meet himI am longing to be cared for — to feel genuine connection and presenceSomething else

How is this showing up in your life right now?I feel it in my body — tension, stress, numbnessIt is affecting my relationship or how I connect with othersIt is affecting my confidence and self-worthI am dealing with a sexual issue — performance anxiety, erection, ejaculationI feel numb or disconnected — intimacy doesn't feel naturalI have experienced loss, grief, or a major life transitionSomething else

In your own words — what is happening for you right now that brings you here?

When you think about this retreat, what feels most true?☐ I want to feel something real — to come back to my bodyI want to make a real, lasting change — not just insightI have been thinking about this for a while — today feels like the right momentI want a full day dedicated entirely to myself — no distractions, no responsibilitiesI am ready to be guided — to surrender and trust the processI still feel a little unsure but something in me is curiousSomething else

What is the one thing you would most like to focus on or get help with during the retreat?

Have you worked with a Tantra practitioner or intimacy coach before?No, this is new for meYes, a littleYes, I’ve worked with someone regularlyI’ve worked with Dea before

Relationship status

Any physical health conditions Dea should be aware of?

Is there anything else you’d like Dea to know

Which best describes where you are right now?I am ready to book the Embodied Man Retreat — 8 hours, €850I would like a confidential consultation first — 20 minutes, €40

Consent

Everything shared in this form and in all sessions is completely private & confidential. Dea does not share your information with any third party.

Consent *I understand that my information is confidential and will not be shared

Boundaries

This work is Tantra and somatic in nature, conducted within a clear framework of consent, boundaries, and mutual respect. Dea reserves the right to end a session at any point if her guidance or the agreed boundaries of the work are not followed.

Boundaries *I understand the nature if this work, and I agree to follow Dea’s guidance and work within the boundaries of the session at all times.

Booking information

Once you submit this form you will be directed to the booking and payment system to confirm your session."

If you are unable to pay online, you can submit this form and contact Dea directly via WhatsApp or message on +353 087 409 7943 to arrange an alternative option. Submitting this form alone does not guarantee a booking.

Embodied Man Retreat Confidential Consultation Form