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Pleasure Practice New Client Form

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.

Personal Information

Emergency Contact

Pleasure Practice

Payment Details

Consent

Dr. Nicole provides education and experiential guidance designed to support your relationship to pleasure, embodiment, relationships, and personal growth. Our work together is a collaborative process that involves a meaningful commitment of time, energy, curiosity, and attention. You are encouraged to communicate openly about your experience, including what feels supportive, what is or is not working for you, what you would like more or less of, and any questions, concerns, boundaries, or feedback that arise.


Our work may include conversations about sensitive or personal topics as well as somatic, relational, reflective, or experiential practices. These experiences may bring up emotional or physical discomfort, unexpected feelings, memories, insights, or shifts in how you understand yourself, your relationships, and your desires. Each person's experience is different, and specific outcomes cannot be guaranteed.


Your agency and consent are central to this work. You determine what you share and which practices you engage in. You may ask questions, communicate boundaries, decline, pause, or modify any practice, and you may choose to discontinue participation at any time. You are encouraged to communicate with Dr. Nicole whenever something does not feel supportive, when a boundary arises, or when you would like to approach the work differently.


Either you or The Pleasure Practice LLC may choose to end the working relationship in accordance with the Terms & Conditions. If Dr. Nicole determines that the work is outside the appropriate scope of services or is not appropriate for your needs, she may recommend additional or alternative resources or referrals. By signing below, I confirm that I have had the opportunity to review this consent form and The Pleasure Practice LLC Terms & Conditions, and I agree to both.

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Thank you for providing your information. We will explore your responses these questions during your first session. Please reach out should you have any questions.

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