Orgasmic Oracle Application

First Name *

Last Name *

Chosen Name *

Email *

Phone *

Birthday (MM/DD/YYYY) *

Time of birth *

Birth City *

How did you hear about Orgasmic Oracle? *

Where in your relationships, business, and body, can you sink into more pleasure and less hustle? *

What are the top 3 nagging loops or thought patterns that keep showing up that hijack you from being in the pleasure of the present moment (aka worrying about what has happened, anxious about what might happen next) *

Describe your relationship to your body: *

Knowing that your relationship to your body is a metaphor for your relationship to pleasure, God, the unknown, and nature, what is it that you would like to learn most about this relationship? What would you like to dive deeper into? *

Describe your relationship to money: *

What is the big dream that turns you on and freaks you out? *

Have you been hospitalized or professionally treated for any medical or psychological condition in the past 5 years? *

Are you on ANY prescription medications? If so, what are they, quantity taken, how many times a day, and for how long have you been taking them? * If not, just put "NO" in the box below. *

I, the signee of this application, NOW take 100% responsibility for my physical, mental, emotional, spiritual, financial, sexual, and ALL ENERGY and transactions in the relationship between myself, and anyone associated with The Earth Temple. *

Yes - 100%

Please type "I AM" followed by YOUR NAME *

Today's Date *