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Welcome. I am so glad you are thinking of starting coaching session with me. Take a moment to answer the questions as honestly as you can. I will contact you with my next availability for a chat.
NOTE: I do not work with men alone. Please find a provider that will fit better for your needs.
Your name *
Your email address *
Your phone number *
What is your gender identity? *
Which country are you currently living in? (Note that Adeline offers session for people living in America and Europe only) *
The time zone for coaching session are Pacific Standard Time, will that work for you? *
Group age *
Where did you hear about sexcoachadeline? *
Are you ready to invest in your sexual wellbeing? *
What time is best for you? *
Please describe your current goal. (Why are you here?) *
What are some challenges you find sexually? And what  would you like to improve? *
Describe your last pleasurable sexual encounter? *
What is the relationship between your sexuality this year versus five years ago? *
What is your ideal sexual situation? Location? Person? What’s happening? *
What are your sexual turn offs and turn ons? *
What is your relationship with your genitals? Do you like your genitals or do you have mix feelings about them? *
Are you currently in a sexual or a nonsexual relationship with someone? How do you feel about this or these relationships? *
What types of foods do you eat on a daily basis? What are some of your favorite foods? Do you exercise much? *
Are you currently under medication?
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Are you addicted to substances or porn?
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