Name *

Name

First Name

Last Name

Date *

Date

YYYY

Email Address *

Email OK? *

Yes

Phone *

Phone

(###)

###

####

VM OK? *

Yes

How did you hear about me? *

About Somatic Sex Coaching

Whatever your motivation for deepening into your erotic self, ALL OF YOU is welcome here. Somatic sex coaching sessions are built on a foundation of professionalism, clear consent and well defined boundaries to ensure the safety, comfort and efficacy of the work we’ll do together. Hands-on touch, inclusive of genital and anal touch, are offered at the request of the student and when deemed appropriate by the practitioner. This touch will always be in service to your learning experience, one-directional (from practitioner to student) and will keep physical safety and hygiene as a top priority alongside your spiritual and emotional well being.

About You

Gender *

Pronoun(s) *

Date of birth *

Date of birth

YYYY

Sexual orientation *

Relationship orientation *

Single

Dating

Partnered

Other

Monogamous

Polyamorous

Monogamish

Undefined

Gender(s) & ages of any current partners *

Children & ages *

Spirituality/Religion *

In your own words, what is your intention for seeking somatic sex coaching? *

Please describe what is currently most gratifying about your intimate life *

Please describe what is currently most challenging about your intimate life. *

Sexual Attitudes & History

1-2 sentences describing your attitudes and/or experience about each. You may select only those that feel most relevant to your intention if you wish and there will be time for us to talk more in depth.

Your body

Your upbringing

Sex

Masturbation

Peak erotic experience(s)/biggest turn-ons

Orgasm

Pleasure/fulfillment

Oral sex

Anal sex

Sex toys & accessories

Sexual fantasy

Sexual trauma

Any other topic you wish to address

Thank you! Now please fill out the coaching agreement form.