Please provide the following information and answer the questions below. If anything does not apply to you simply write N/A or leave blank. Feel free to skip any questions you are not comfortable answering or place a star next to anything you would like to talk about but do not want to write down.
Dr. Nicole has sent a secure Stripe link via email for your first session payment. During checkout, be sure to select the option to save your credit card on file. By doing so, you consent to future session payments being charged to this card in accordance with your scheduled sessions.
Please complete this payment prior to your first session, as session fees are due at the time of booking.
Dr. Nicole provides education and experiential guidance designed to support your relationship to pleasure and embodiment. Engagement in services is a collaborative process that requires a significant commitment of time and energy. This process works best when you are willing to share openly and explore with Dr. Nicole the feelings, thoughts, and experiences that arise over the course of our work together. This includes what you have noticed about the progress of your relationship to pleasure, feedback for Dr. Nicole around what is and is not working and what you would like more of, and any concerns you may have about our work together. At times, this may involve pushing your comfort zone, but generally results in better outcomes and a greater connection and alliance with Dr. Nicole.
This work may involve discussing sensitive topics, somatic exercises, or experiential practices that can evoke emotional discomfort. Participation in all practices is voluntary, and I may pause or withdraw at any time. Either the client or The Pleasure Practice LLC may choose to terminate the working relationship at any time for any reason. If The Pleasure Practice LLC determines that this work is not appropriate or effective for my needs, Dr. Nicole may recommend other resources or referrals.*
I understand and agree to the fee structure, scheduling arrangements, and that payment is due at the time of booking. I will make payments as agreed upon and adhere to the cancellation policy of 48 hours’ notice, or the full session fee will be charged. By signing, I authorize The Pleasure Practice LLC to charge my credit/debit card in accordance with the agreed payment terms and cancellation policy.*
By signing below, I confirm that I have read, understand, and agree to the information provided in this consent form and the Pleasure Practice LLC terms: https://www.modernanarchypodcast.com/pleasure-practice-terms*
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Thank you for providing your information. Dr. Nicole will explore your responses to these questions during your first session. Please reach out should you have any questions.
