PRE-QUALIFICATION INTAKE FORM

What called you to this mentorship? Why now?

What’s your current relationship to your s€xual energy and desires? Is there shame, addiction, performance anxiety, numbness, or disconnection present?

Are you currently watching porn, experiencing ED, using pills to perform, or hiding your deepest erotic desires from partners?

Have you explored intentional self-pleasure as a path of healing, mastery, or transformation? If yes, describe. If not, what has held you back?

What’s the deepest or bravest inner work you’ve ever done? What did it show you about who you are?

If accepted into this mentorship, what would you need to release, sacrifice, or restructure to go all in?

What embodiment or spiritual practices (if any) do you currently engage in — breathwork, movement, meditation, cold exposure, inner child work, etc.?

Are you aware of any trauma (early childhood, s€xual, relational, spiritual)? What healing work have you done around this — and where are you still holding pain?

What is your current relationship to psychedelic medicines (if any)? Please list all psychedelics you have worked with and in what capacity.

How have you previously invested in your growth — and what was the outcome?

Full Name

On a scale of 1–10, how ready are you to be called forward, held accountable, and penetrated with unwavering truth?

If you feel deep alignment on our call, are you able to invest multiple $ four-figures+ to breakthrough into your Savage Lover King?

Phone Number (for text updates)

Social Media Handle(s)

How did you find me / this offering?

Do you have a supportive community of brothers or sisters that you are apart of?

Email (to save your contact)

Phone Number (that I can text you on)

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PRE-QUALIFICATION INTAKE FORM

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