Try a Nourished Woman Weekend RetreatSoak up the beauty of OntarioGift yourself the gift of Nourishment

Try a Nourished Woman Weekend Retreat

Experience the amazing energy! When women gather, magic happens and memories that last a lifetime are made!

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Soak up the beauty of Ontario

Escape for a Nourished Woman Weekend of amazing workshops and fabulous food!

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Gift yourself the gift of Nourishment

The perfect freedom from the hustle and bustle of daily life, a Nourished Woman Weekend to recharge the soul!

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Vaginal Steam Intake Form

Welcome and thank you for investing in this powerful tool for the health of your womanhood! We are grateful to be part of this incredible journey with you! Please note that all information you submit is strictly confidential. Should we use your info in a case study, your name will not be published. We understand that there are some things that may be emotionally difficult to talk about and we want you to feel completely confident that we are here to offer loving kindness and support.

Before we start, please note that we offer some options for purchase. Items are available individually, and also grouped in packages for great savings. All purchases can be made in our Etsy store.

Consultation and continued support: $25. The Individual Consultation and continued personal online support is a wonderful tool to fine tune your Peri-Steam Hydrotherapy exactly to your current needs. This will give you the most accurate and effective protocol for your priorities and convenience. The support will be online via confidential email.

Consultation and support with herbs for 15 steams: $65 (save $15) The Individual Consultation will identify the very best herbal blend for your target goals. This combo purchase saves you money and ensures you get exactly what you need.

Consultation and support, bag of 15 steams and pine yoni steam box: $185 (save $40) This is our best deal! We think it’s the perfect combo for getting the very best out of your Peri-Steam Hydrotherapy. This will ensure the correct herbs, detailed steam plan unique to you, and our fabulous Canadian Made pine Yoni Steam Box.

(Please note the additional cost of shipping if your order requires delivery. Shipping rates vary by location. Applicable taxes will be charged at check out)

Intake form will be reviewed only after payment is received and you can expect to receive your detailed personal protocol within 1-3 business days.

Name:*
Address:*
E-mail:*
Phone:*
-
Date of Birth*
How did you hear about Nourished Woman Peri Steam Hydro-therapy (Vaginal Steaming)?*
Have you ever had a vaginal steam before?*
Where are you in the life stage of your cycle?*
Do you suffer from menstrual cramps? If so please check all that apply.
Colour of blood, please check all that appy.*
Type of flow*
If applicable, when was your last menstrual bleed?
Do you feel your cycle can prevent you from living your normal day?*
Please indicate the length of your typical monthly cycle. Example, Day 1 being the first day of bleeding and day 28 being the last day before you bleed would be a 28 day cycle.*
Please indicate the typical length of your flow*
If you selected varying cycle length or don't know my cycle length or bleed length please expand/describe. Include approximate shortest and longest cycle lentghs.
Do you have skipped bleeds or suffer from Amenorrhea?*
Menstrual products currently being used; check all that apply*
Do you currently experience any of the following symptoms during your monthly cycle? Please check all that apply
Pregnancy Info, please check all that apply
How many children have you birthed?*
Current Birth Control Method;
In regard to you bladder please check all that apply.*
In regard to your bowel please check all that apply.*
In regard to vaginal discharge/fluid please check all that apply.*
Please check any of the following conditions that you experience on a regular basis.
Please feel free to expand on the last question if you desire.
Please check all physical conditions that you are currently experiencing.
How would you score the comfort of your average menstrual cycle? One star being very uncomfortable and 5 stars being very comfortable
How would you score your general level of health? One star being very unhealthy and five stars being very healthy.
How active are you on a weekly basis, one star being inactive and 5 stars being very active.
How much water do you drink in a typical day?
Check any health conditions that apply to you.
How comfortable are you talking about your menstruation and or Ladyscape, one star being very uncomfortable and 5 stars being bring it on!
Do you wish to expand on anything or is there anything else important that you feel we should know? If so please use the space provided below.
Do you have any questions or concerns before we begin your personal vaginal steam plan?
What do you hope to accomplish through vaginal steaming?
When to avoid Vaginal Steaming; If you are pregnant or there is a possibility of pregnancy. During or after ovulation if you are trying to conceive. During Menstruation. If you have had heavy spontaneous bleeding mid-cycle within the last three months it is not recommend to do a vaginal steam. It is not recommended to steam after waxing or laser hair removal. We recommend waiting 4 days after waxing and 2 weeks after laser hair removal. Please note that piercings will need to be removed to avoid burns. *
IUD Precautions; Steaming is considered safe with a copper IUD. We do not encourage use with a plastic IUD or plastic intrauterine contraceptive device device including coil, loop, triangle or T shape made of anything other than copper.*
Steaming should not be done when the body is fighting and illness such as the flu or any other fevered condition. When the body is fighting an active infection resting is a priority over steaming. It is important that you listen to your body first and foremost over all guidelines. You should stop your steam if you feel any of the following; generally unwell, light headed, dizzy, nauseous, intense headache, short of breath or if your body tells you so, trust your instincts.*
Burn risk; Just like drinking a hot beverage like tea or coffee there is a chance to burn yourself if you do not first test the temperature by placing a sensitive part of your body, like the inside of your elbow, over your box. *
Do you wish to purchase a Nourished Woman Steam Box? They are in high demand and we will set one aside for you if so. They cost $145.
LIABILITY AGREEMENT; I certify that the above information is true and complete, to the best of my knowledge. I fully understand that I am solely responsible for my health, safety and well-being while vaginal steaming. I agree to consult my physician if I am in doubt of my ability to use the Vaginal Sauna for health reasons. I understand that the use of drugs, medication or alcohol prior to or during the vaginal steam session may lead to dizziness or unconsciousness. I will discontinue the use of the vaginal steam immediately if I feel light-headed, dizzy, heat exhausted, feel unwell or my body or intuition tells me to do so. I understand I should drink plenty of water before and after a vaginal steam session. I understand that there are risks associated with any health treatment including vaginal steaming. While every precaution shall be taken to ensure the good welfare during a steam session or in the preparation of herbs or a personal steam plan, The Nourished Woman Team, staff members, employees, volunteers, or facilities are hereby released from any liability in the event of any accident or misfortune that may occur from the result of vaginal steaming.*
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