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Professor Sex - One-on-One New Client Intake
ProfessorSex.com
Sex and Relationship Coaching
One-on-One Education
Email address *
Preferred Name *
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Phone Number *
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DOB *
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Skype or Google Hangouts Username (please specify which)
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Time Zone *
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Is it okay to send you emails? *
What is your preferred method of contact? *
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How did you hear about me? *
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Have you ever retained the services of a mental health professional? If yes, please describe that experience. *
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Are you currently working with a therapist or mental health professional? If yes, in what capacity and how often do you see them? *
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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? *
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Have you ever worked with a coach or personal educator in the past? If yes, describe that experience *
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What is motivating you to work with a sex and relationship coach at this time? *
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What do you expect or hope to get from our time together? How do you hope I can be the most helpful to you? *
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Is there any additional information you’d like me to be aware of. *
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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 except that I do keep notes from the sessions for my own records and because I am under supervision with AASECT for sexuality education certification. I may, therefore, share those notes with my clinical supervisor. All information shared with her would be anonymous and for the purposes of accountability on my part and in pursuit of excellence in my practice. If you have any questions, please reach out to me at angel@professorsex.com. I look forward to working with you! Thank you! *
Thank you for this. Due to a high volume of response, If we have not already spoken, I may not see your submission. Please email me at info@professorsex.com to let me know you've completed this form and would like to be contacted. Thank you so much!
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