Preliminary Questionnaire

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The Ultimate Massage For Men

Preliminary Questionnaire

learn what others have to say about their private sessions

contact tele # (612) 823-0496

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Please be sure that you have completed the session request form on the previous page entitled "How To Request a Private Session" before submitting your responses to the questionnaire below.

Failure to do so may result in a delay in processing your request.

*** IMPORTANT NOTICE ***

The forms submission feature on both this page and the previous "How To Request a Private Session" page are currently NOT operating properly.
In order to submit your questionnaire responses follow the link below (the link to the "session request" form is located on the previous page beneath this same notice).
After you have submitted your session request form and your "Preliminary Questionnaire" by the new links provided, you MUST send me an email to let me know that your forms have been completed. I can then look for them and get back to you regarding availability and scheduling.
My apologies for this temporary inconvenience.

to submit your responses to my "Preliminary Questionnaire, click here

click here to send me an email

In an effort to provide you with the most enjoyable and beneficial experience possible, I ask that you complete the following questions to the best of your ability and submit this information to me as soon as possible.

Your answers will be kept in the strictest of confidence.

Or I can e-mail a copy of this "Preliminary Questionnaire" to you.

Thank you for helping me make your session a much more rewarding experience.

*** if you have not received a response from me within 24 hours after submitting your questionnaire responses - or you received any kind of error message after pressing the submit button above - please contact me directly via email or telephone

PRELIMINARY QUESTIONNAIRE

*** As a reminder, the form below is temporarily NOT operational -

to submit your responses to the "Preliminary Questionnaire," see the alternate link above ***

Name
E-mail address
Telephone
best time to call
Date of Birth
Height
Weight
Occupation
"Preferred" days / times for your session
Length of session requested
Type of session requested
1) Have you ever received a therapeutic massage before? (If not, please proceed to question # 9)
2) Have you ever experienced any of the following types of massage or bodywork? (List all that apply) Acupressure, Hand/Foor Reflexology, Swedish, Sports, Shiatsu, Belgian, Watsu, Esalen, Cranial/Sacral, Lomi Lomi, Rolfing, Body Electric (Taoist), Trager, Amma, Oriental, General Deep Tissue, Chiropractic Adjustment, Archier Massage Technique, Benjamin System of Muscular Therapy, Bindegewebsmassage, Lymphatic Massage, Pfrimmer Deep Muscle Therapy, Lauren Berry Method, Bowen Technique, Trigger Point Therapy, Trager Psychophysical Integration, Ortho-Bionomu, Body Logic, Aston-Patterning, Hellerwork, Postural Integration, Soma Neuromuscular Integration, CORE Bodywork, Myofascial Release, Alexander Technique, Gerda Alexander Eutony, Mensendieck System, Feldenkrais Method, Hanna Somatic, Other
3) What did you MOST enjoy with regard to your previous massage / bodywork experience(s)?
4) What did you LEAST enjoy with regard to your previous massage / bodywork experience(s)?
5) With your previous experience(s), were any of the following elements included which you found particularly enjoyable? (List all that apply) light touch, "feathering" strokes, deep tissue, muscle stretching, heated oils, soothing music, sauna, whirlpool, heated table, facial mud/clay packing, colored lighting, guided deep breathing, guided relaxation
6) With your previous experience(s), were any of the following elements included which you did NOT enjoy? (List all that apply) light touch, "feathering" strokes, deep tissue, muscle stretching, heated oils, soothing music, sauna, whirlpool, heated table, facial mud/clay packing, colored lighting, guided deep breathing, guided relaxation
7) Do you receive massage / bodywork on a regular basis?
How often?
8) Approximately how long has it been since you received your last massage / bodywork session?
9) Your entire body is treated with honor and respect. Are there any particular areas of your body that you specifically request be avoided? (List all that apply) scalp, forehead, temples, eyebrows, eyelids, nose, sinuses, cheeks, jaws, ears, lips, chin, neck, throat, shoulders, axillary regions (underarms), upper arms, elbows, lower arms, wrists, hands, fingers, chest, sides of torso, abdomen, hips, pelvis, genitals, perineum (the region between the scrotum and the anus), upper legs, knees, lower legs, ankles, feet, toes, back of head, back of neck, upper back, middle back, lower back, buttocks, thighs, patella, calves
10) Are there any particular areas of your body that you especially enjoy having massaged or which need special attention? (List all that apply) scalp, forehead, temples, eyebrows, eyelids, nose, sinuses, cheeks, jaws, ears, lips, chin, neck, throat, shoulders, axillary regions (underarms), upper arms, elbows, lower arms, wrists, hands, fingers, chest, sides of torso, abdomen, hips, pelvis, genitals, perineum (the region between the scrotum and the anus), upper legs, knees, lower legs, ankles, feet, toes, back of head, back of neck, upper back, middle back, lower back, buttocks, thighs, patella, calves
11) Do you have any range-of-motion problems with any of your extremities?
12) Are there any areas of your body which are sensitive and/or ticklish to the touch?
13) Have you ever practiced any of the following forms of guided relaxation? (If not, please proceed to question # 17) (List all that apply) meditation, guided visualization, autogenic training, self-hypnosis, yoga, stress management, tai chi, other
14) What did you MOST enjoy with regard to your experience(s)?
15) What did you LEAST enjoy with regard to your experience(s)
16) Do you practice guided relaxation on a regular basis?
How often?
17) Do you find that generally you are able to relax easily?
18) Do you experience an excessive amount of stress in your life? (If not, please proceed to question # 22)
19) In what area(s) of your life do you experience the greatest amount of stress? (List all that apply) job, inter-personal relationships, health, finances, other
20) Have / do you practice(d) any specific stress management techniques? (If so, please specify)
21) Did / do you find these techniques helpful?
22) Have you had any major surgery in the last six months? (If so, please specify)
23) Have you had any recent serious injuries? (If so, please specify)
24) Do you have any inserted corrective metal plates, pins, insets, etc.? (If so, please specify)
25) Do you wear any of the following? contact lenses, dentures, hearing aids, hairpieces, prostheses
26) Do you have any known allergies? (If so, please specify)
27) Do you have any chronic or recurring health challenges (e.g.: high fever, cancer, tuberculosis, hypertension, gastric or duodenal ulcers, varicose veins, diabetes, phlebitis or other vascular problems, swollen limbs, heart disease, epilepsy)
28) Do you exercise / work out on a regular basis?
How often?
29) Would you feel comfortable receiving your session in the nude (optional)?
30) Would you feel comfortable if I were also nude during your session (optional)?
31) It is not uncommon for a client to experience an erection during a session, even when parts of the body other than the genitals are being massaged. Would this make you feel uncomfortable?
32) Realize that if what you are seeking is simply a "sexual massage", you most likely will not be interested in the depth and the intensity which my sessions entail. However, often (but not always) the awakening and stimulation of chakral energies unfolds in a very dynamic and intrinsic fashion. This frequently leads to a climax of sexual energies and even sometimes results in an ejaculatory experience. Would either of these experiences make you feel uncomfortable?
33) Would you like to share any information about an especially ENJOYABLE previous massage or bodywork experience?
34) Would you like to share any information about a particularly UNENJOYABLE previous massage or bodywork experience?
35) Are you of legal age in the municipality in which you reside?
36) Are you employed by any law enforcement or public regulatory agency?
37) Will you be paid (or in other means compensated) by a third party to participate in this experience?
38) Are your interests in participating in a private session motivated solely by your interests in the therapeutic benefits which might be derived from the experience?
39) How did you first hear about my services? (Pleas be as specific as possible - just saying "internet" isn't very helpful) Referral from friend? Online massage directory? AOL / gay.com chat room? Magazine / newspaper ad (name of periodical)? Number written on bathroom wall (tell me more)? Your astrological forecast? Ouija board? A spirit from "the other side"? My name and number came to you in a dream? Crop circles? Tea leaf reading? (you get the idea) :-)
40) What additional information can I provide to help better prepare you for your session?
41) In your own words, please describe as best you can exactly what you are looking to experience during a private session. The more thorough your explanation, the greater the chance of your request for a private session being approved

Thank you for your time and assistance in providing this valuable information.

By submitting this information, you are certifying that you are of legal age (considered an adult) in the municipality in which you reside.

By submitting this information and requesting a private session with me, you are certifying that you are not a member of any law enforcement or public regulatory agency.

By submitting this information and requesting a private session with me, you agree that you are willingly and authentically expressing an interest in participating in this experience and are not being paid by any third party to attend this session and are acting of your own free will as a consenting adult solely for the therapeutic benefits which may be derived from the session.

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