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Professor Sex - One-on-One New Client Intake
Sex and Relationship Coaching
One-on-One Education
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Email *
Preferred Name *
Phone Number *
Skype or Google Hangouts Username (please specify which)
Time Zone *
Is it okay to send you emails? *
What is your preferred method of contact? *
How did you hear about me? *
Have you ever retained the services of a mental health professional? If yes, please describe that experience. *
Are you currently working with a therapist or mental health professional? If yes, in what capacity and how often do you see them? *
Do you have any medical conditions I should be aware of? Are you taking any medications I should know about related to your sexual health or relationship questions? *
Have you ever worked with a coach or personal educator in the past? If yes, describe that experience *
What is motivating you to work with a sex and relationship coach at this time? *
What do you expect or hope to get from our time together? How do you hope I can be the most helpful to you? *
Is there any additional information you’d like me to be aware of. *
By retaining my services, you acknowledge that you are seeking coaching and education related to questions or goals you may have around sexuality and relationships. You acknowledge that I am not a mental health professional or physician. If it should become evident that those services might be the best resource for meeting your needs, whether in place of or in conjunction with our sessions, I will communicate this to you and do my best to help you find a sex-positive professional who will help further your growth and well-being in line with your goals and personal priorities. I do not work with Sexual Surrogates and one-on-one educational sessions do not ever involve any nudity, inappropriate touching, or sexual activities and requests for such will be denied. Should such behavior occur during a session, I reserve the right to end the session without notice and without reimbursement of fees. Confidentiality: Please note, anything you share with me is confidential. This means that while I do sometimes share anonymous stories about what I learn from my clients and students, all identifying information about you and your story will stay between us unless you choose to share it with someone else. If you have any questions, please reach out to me at I look forward to working with you! Thank you! *
Thank you for this. Due to a high volume of response, I may not see your submission. Please email me at to let me know you've completed this form and would like to be contacted. Additionally, completion of this form does not, on it's own, mean that we have entered into a client/coaching relationship. Those agreements need to be made verbally or via email. Thank you so much! *
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