What are you hoping to get out of your coaching experience? 
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              What does "Intimacy" mean to you? 
              
             
          
                
                
                
                
                
                
                
                
                
                
                
                
                
                
                
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
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              What are some of your important identities? (examples include: race, ethnicity, gender, sexual orientation, survivor, parent, sibling, religion, immigrant, US citizen, education level, income level, athlete, belonging to a specific group, etc. 
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              How do you feel about touch? 
              
             
          
                
                
                  
                
                  
                
                  
                
                  
                
                  
                
               
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
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              Are you hoping to learn to be more in your body, rather than in your head? 
              
             
          
                
                
                  
                
                  
                
               
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
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              How satisfied are you in your current intimate relationships? 
              
             
          
                
                
                  
                
                  
                
                  
                
                  
                
                  
                
               
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              How satisfied are you in your current social interactions?
              
             
          
                
                
                  
                
                  
                
                  
                
                  
                
                  
                
               
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Have you ever experienced sexual trauma? If yes, please share what you feel comfortable sharing.
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Is sex ever painful for you?
              
             
          
                
                
                  
                
                  
                
                  
                
               
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
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              Do you have any medical issues that impact your sexual satisfaction? 
              
             
          
                
                
                  
                
                  
                
                  
                
                  
                
               
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Other:
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Do you feel that you have a rich fantasy life? 
              
             
          
                
                
                  
                
                  
                
                  
                
               
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Other:
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              To map your "core desire" in coaching, we will explore "common turn-ons" that you may resonate with. Select any from the list below to get us started. 
              
             
          
                
                
                
                
                
                
                
                
                
                
                
                
                
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Name
              
             
          
                
                
                  
                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
                * 
              
             
          
                
                
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Phone
              
                * 
              
             
          
                
                
                  
                    
                      Country 
                     
                  
                
                
                  
                    (###) 
                   
                
                
                  
                    ### 
                   
                
                
                  
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