Sex Coaching with Dr. Anya - Interest Questionnaire.
Please fill out this form so that we can find out quickly if we will be a match for working together. I will get back to you ASAP. Thanks!
What is your name and email address? *
Your answer
Are you an individual or a couple? *
What is your gender(s)? *
Your answer
Why are you seeking sex coaching at this time? *
Your answer
Have you received a medical diagnosis related to your sexual concern? Please specify. *
Your answer
Are you in a committed relationship? What are some of the strengths and weaknesses of the relationship? *
Your answer
Do you have any doubts about your relationship? Why? *
Your answer
What are 3 areas you wish to grow in related to your sexuality? *
Your answer
Have you had therapy or coaching in the past? If yes, tell me a little about that experience. *
Your answer
Are you able to do day time appointments? *
Your answer
Are you able to do online sessions using your computer or smart device? *
Your answer
If I am not able to work with you at this time would you like a referral? If yes, are you open to a therapist or coach? Do you have a gender preference or any thing else you'd like me to know? *
Your answer
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