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Intimacy & Relationship Coaching Intake Form
Please fill this out before our first session. Thank you!
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Name:
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Your answer
Age:
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Email Address:
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Your answer
I am interested in and/or curious about:
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Tantra
Sexological Bodywork
Sex & Intimacy Coaching
Relationship Coaching
Spirituality
Other:
Previous experiences with this or similar work:
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Your answer
Previous experience with therapy/coaching:
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How did you hear about us?
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With regard to our sessions, what do you desire to walk away with?
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Current relationship status:
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How would you like your life/relationship to shift after doing this work?
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Your answer
Wonderful things about me/my relationship I'd like you to know are:
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Difficult things about me/my relationship I'd like you to know are:
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Please share any other information pertaining to your relationship that may be relevant:
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Wonderful things about my sexuality and/or sexual history I want you to know are:
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Difficult things about my sexuality and/or sexual history I want you to know are:
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Please share any other information you feel may be relevant:
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