Clarity Questionnaire
This form will help me discover more about you and your needs. There are no right or wrong answers . There is also nothing to be ashamed of.
Please tell me your name.
Your answer
Are you married or in a long term relationship? *
Your answer
How long have you been together?
Your answer
Do you feel like your partner isn't meeting your sexual and intimate needs?
Your answer
Do you feel like your wants and needs are not understood? *
Your answer
Do you feel like you have trouble communicating with your partner? *
Your answer
Do you have any insecurities about your body or skill level?
Your answer
Have you been experienced shame in the past because of sexual choices?
Your answer
Do you have any issues sexually that you have trouble talking about or understanding?
Your answer
If you could get any result from our call together, what would it be? *
Your answer
Leave me your email if you would like to be kept in the loop? *
Your answer
What would you like from me during your session: select all that apply *
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