Coaching Intake Form: How to Improve Intimacy Find an Intimacy Therapist and Intimacy Coaching Leave this field blank Welcome! I look forward to learning more about you... (optional) Contact Information: Please provide your name and contact details below (optional) First and Last Name(s) Email address(es) Your Phone Number(s) Gender(s) (optional) Male Female Gender not listed Couple Age(s) (optional) Occupation(s) (optional) How did you find me? Google Search Referral Other Q&A Thank you for your interest in my work. To the best of your ability I would love for you to answer the following questions. It’s a simple way for me to get to know you a little better. Answer as completely and authentically as you can. I will follow up with you to determine how we might best work together. Your privacy is very important to me. Any information given to me will be treated with the utmost confidentiality and respect. Please let me know which offering(s) you’re interested in: Ask Me Anything/Tell Me Anything starter session Personalized Intimacy Coaching session(s) Erotic Blueprints® 2 hour intro session An Erotic Blueprint Breakthrough Program package (Basic or Premium) Couples Intimacy Coaching Other If “Other”, please share more details with me: (optional) Please describe what has drawn you to seek out this type of work and why you might be interested in working with me as your practitioner. (optional) What issue/s would you like my support with within the context of this work? (optional) What would you like to change about your current situation? (optional) What do you feel has blocked you from experiencing this before now? (optional) What will you have achieved, accomplished, acquired, and/or become at the end of our time together that would have you know our work together was worth every second and every penny to you? * Do you have experience with any of the following: (optional) Tantra Meditation Breath Work Massage Dance Yoga Martial Arts Non-Violent Communication NLP Reiki Other (please specify below) If yes to any above, please tell me a little bit more about those experience(s): (optional) Are you currently single, dating, in partnership, married, or other? (optional) Do you consider yourself spiritual or religious? If so, can you tell me a little about what this means to you? (optional) How do you feel about your body and general health? (optional) Describe your relationship with your emotions. (optional) How would you define what it means to be erotically intelligent? (optional) What would contribute to your erotic empowerment, satisfaction and evolution where you’re at currently in your life? At times the work we do together may be challenging. Are you willing to move through this if it means we are making progress? (optional) And finally, from what you know about yourself, would you say you benefit more from getting to talk in detail about things that have happened in your life (as they relate to the work we’ll be doing) or would you prefer we cut straight to the chase and focus on healing and integration work with you sharing only minimal context? I can guide either, but different people do better with different approaches. Which approach do you tend to like more? Is there anything else you would like me to know about you? (optional) Are there any questions you have for me or additional things you’d like to know? (optional) If you'd like to schedule a discovery call with me to discuss any of the above, you can do so at this link: https://calendly.com/claire-lets-connect/30min Send
