intake form | Maine Intimacy

First name

Last name

Email

Phone

Partner’s name (if both of you are coming)

What brings you to sex coaching?

What would you like to tell me about your current intimate relationship/s?

Are there challenging things from your sensual/sexual history that you want me to know?

Please share any experiences you've had with sexual assault or trauma that you feel might affect our work together. If you would prefer to have that conversation over the phone or in person, please make a note of that here.

How would you like to feel at the end of our work together? What is your desired goal?

Tell us about yourself before our visit