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Welcome to Closeness. This is an optional intake form. I’m San Diego’s top rated sex, intimacy and relationship coach. If you’re experiencing any challenges in your relationship or single life, you’ve come to the right place.

All fields are optional except for your contact information. If you wish to skip the form and go right to scheduling an appointment on Calendly with me, you can tap or click HERE.

This form is not shared with your partner. However, these subjects are likely to come up, given why you’re coming in. If there are any answers you prefer to keep private, please let me know on the last question of this form in section four.

You are about get real help, presented in a very unique and interactive format. I’m highly competent at making your experience feel comfortable, safe and even exciting when appropriate. If you haven’t done so already, visiting the coaching section of this site for fees and more info, listening to the podcast and reading reviews may also be helpful. I’m looking forward to meeting you!

Closeness inTAKE FORM

Hello, what is your full name?

Email

Phone

Dates for your first appointment

Age

Together or by yourself?

Offspring

Describe your work

Your current sex drive

If applicable, how does it compare to your partners?

Time together if you're involved with someone

Sex work

What's working?

Sexual attraction to one another

How well do you communicate?

What are you struggling with?

How can I help?

Has there been betrayal on yours or their part?

In terms of getting these things taken care of, where are we?
CHECK ALL THAT APPLY

Last ditch effort It has been going on for a while but we haven’t addressed it I've been trying to address it with other coaches and therapists with little or no results I'm have some issues and want to address it before it gets worse I'm here to learn more about my body and how it works I am curious about reaching orgasm or other types of pleasure such as my g spot, a spot, squirting or clitoral orgasms Things are great but I want to learn to be a better lover I would like you to show my partner how to excite me and get me going I would like you to show me how to get turned on in a more erotic or assertive way or learn more skills in this area

If you're having sex, how is it?

Sexual Intimacy other than sex

Do you wish there was more of this?

How often are you having sex?

Is lack of sex or too much sex a deal breaker?

Do you watch porn? How often?

How do you like to have sex initiated?

Being affectionate, soothing and loving

How often are you in touch with yourself?

Do you think your strategies are effective at getting you what you want?

If you don't lean towards initiating sex, how does your partner know you're ready or want it or should make the move?

Expectations about sex

Meds, pills and drugs

Rejection

Initiation

Turning them on

Taking the lead and knowing how to do it

Communication

I would like my relationship to remain

Monogamous Open in some way I am open to anything I want to stay single and have fun I want my partner to only want me I am committed to my partner and love them but crave and want causal encounters or to have sex with others I’d like to get out of this relationship and need some help communicating this to my partner Other

Relationship with your parents

Religion

More details

Orgasm struggles with or without your partner?

Do you both reach orgasm regularly, even if not at the same time?

A little more

The female orgasm

Additional stimulation

Any restrictions on consent to discuss? Privacy and confidentiality

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Fill out an optional Intake Form to get started or schedule your session now, on Calendly. All sessions are in-person and Zoom is available on request. You can also book a phone session.

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