Name

Email Address

Please answer the following questions... Your Full Name: Phone Number #: Individual or Couple: Have you ever worked with a sexuality coach/therapist or have you ever done a sexuality program or any kind? Which one and how did it go? What do you want in your sex life? What do you feel like your major stumbling block is for getting what you want? Are you willing to invest time and money in creating change in your love life? Describe your relationship(s), if have currently. Where is it headed? What will it look like in 12 months? What strategies are you currently doing and how are they working for you? How are you holding yourself back from what you really want? What do you most want to learn or achieve? Anything else you want us to know to be considered for this program?