Intake form women

Enter your first name *

Last Name *

Enter your Email *

Phone *

Skype profile

Are you single, married, or in a relationship? If you have a partner how long have you been together? *

Please share your age *

Do you have any children? How many and how old are they? *

On a scale from 1 -10 How would you rate your current sexual experience? *

What is motivating you to explore your sexuality right now? Has anything happened to kick start this adventure? *

What are the three biggest obstacles you experience in your sex life? *

What areas of your sex life would you most like to improve? *

If you could get one thing from our sessions together what would it be? *