Personal Intensive Intake Form

Intimacy Coaching and Therapy for Couples

Your First and Last Name

Your Email Address

Your Phone Number

Your Gender (optional)

Pronouns (optional)

She/her

He/him

They/them

She/them

He/them

Not listed

Your Age (optional)

How did you find me? (optional)

What length of personal intensive are you interested in?

4 hours

6 hours

8 hours

Please share with me your thoughts, ideas and inspirations about what you might like to learn during a personal intensive. We will have 4-8 dedicated hours to focus on anything you'd like. What might you like us to focus on?

What has inspired you to want to have a personal intensive and to focus on the areas you mentioned above?

What has inspired you to want to work with me specifically? (optional)

What are some intentions/outcomes you hope to achieve personally (or even professionally) beyond just learning new things by having a personal intensive with me? (optional)

Is there anything else you’d like to share about yourself, where you currently are in your life, significant things about your erotic journey, etc to help me get to know you better?

Do you have any questions for me?

I usually offer intensives on Fridays between 10am - 6pm, though other days are possible. Please share with me dates and times of your upcoming availability and when you might like to have our intensive. (optional)

Feel free to schedule a discovery call/AMA session with me so we can answer all your questions and make sure we craft the ideal experience for you. Use this link here: (optional)

https://calendly.com/claire-lets-connect/30min

If you're unable to find a time in my Calendly for a discovery call, please send me an email at hello@clairerumore.com so we can find other dates/times that can work.

Thank you