Endocrine Steam Intake Form

Please fill out this form and be as accurate as possible with your answers.


There are times when it is not beneficial for a woman to steam. First, let's make sure you don't have any contraindications.

*The selected conditions above suggest that you are contraindicated for steaming. You are not safe to steam and could result in negative side effects such as the onset of bleeding or miscarriage. Steaming should not be performed at this time.

*If you are using the above birth control methods vaginal steaming could cause a birth control failure. It is not recommended unless you have a backup form of birth control or possible pregnancy is not a concern.

*If you have a burning itch the warmth from the steam could be uncomfortable since there is already so much heat in that area. It is best to seek treatment from an acupuncturist to get the burning sensation to go away prior to doing a vaginal steam session.


Steam may cause a physiological response in some women. In this case, the practitioner will adjust the steam session and herbs that perfectly suit you.

*The answers above indicate sensitivity in which case a mild setup, should be performed 10-15 minutes. Under no circumstances should clients who have sensitivity use an advanced setup which is 25-30 minute steam sessions.

Herb Selection

It is best to select herbs suitable to your constitution. The practitioner will use the information from this intake form to select a suitable vaginal steam formula for you.