Intimacy Coaching Questionnaire
Welcome!

 Thank you for your interest in working with me. This high-level, transformational coaching is designed for individuals and couples who are ready to invest deeply in their personal growth, emotional healing, and intimate relationships. Please answer the following questions thoughtfully and honestly.  
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Email *
Name *
Phone *
Current home town or city *
How did you hear about my services? *
Age *
What is your occupation/profession? *
What is your relationship status? *
What drew you to explore intimacy coaching at this time? *
What are your top 3 goals when it comes to your intimate life (either solo or with a partner)? *
What has been your biggest challenge when it comes to intimacy, connection, or sexuality? *
Have you worked with a therapist, coach, or healer before? If yes, what was that experience like? *

On a scale from 1–10, how committed are you to doing deep emotional and relational work right now? (1 = not at all, 10 = fully in)
Please explain your number:

 *
High-level coaching requires time, energy, and financial investment. Are you ready to prioritize yourself and this work in your life right now?
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This coaching is an investment ranging between $2500 and $5000. Are you financially prepared to invest in yourself at this level? *
What do you believe is getting in the way of the intimacy you desire? *
Are there any patterns, beliefs, or past experiences that you suspect are affecting your ability to connect deeply or express yourself sexually? *
What does a fulfilling intimate life look like to you? *
What would success in our work together look or feel like? *
Is there anything else you want me to know before we connect? *
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