Name

Email Address

Phone Number

Age

Relationship Status

What’s The One Thing You Are Struggling With The Most In Intimacy?

Describe What Your Ideal Relationship Would Look Like.

Do You Have Any Self-care Practice In Place? Do You Have Any Self-care Practice In Place? Yes No

If So, Which Ones?

Are You Familiar With Energy Work? Are You Familiar With Energy Work? Yes No

What Would You Get From Coaching That Would Be Most Valuable To You?

Have You Hired A Coach Before? Have You Hired A Coach Before? Yes No

What Was Your Experience?

On A Scale From 1-10 How Ready Are You To Invest In Transforming Your Relationship?

What’s Most Important To You Right Now Regarding Your Relationship: What’s Most Important To You Right Now Regarding Your Relationship: Deeper Connection More Intimacy Knowing Your Boundaries And Having The Ability To Express Them Being Able To Voice Your Needs Having More Time To Focus On Other Things Than Trying To Fix The Relationship Feeling Deeply Confident In Expressing Yourself Sexually Finding A Love Language That Nourishes You Both

What’s Your Primary Interest? What’s Your Primary Interest? I Am Clear I’m Ready To Make Changes And Open To Hiring A Coach I’d Like To See Whether Coaching Is A Fit For Me I’m Not Open To Someone Else Guiding Or Supporting Me

What Else Do You Want Me To Know?