Intake Form

Thank you for requesting a Private Sex Coaching session. Please set some time aside to fill out this form as completely as you can. This is a secure form; your information will be kept private in accordance with my privacy policy.

If you have not yet requested a session, email to get started.

Sex coaching assists clients with matters such as sexual intimacy, personal challenges, and relationships. A coach is in a partnership with the client to help improve their personal life. The focus is to help the client consciously create a vision and goals for life. Coaching helps clients think differently and learn what’s best for the individual. Coaching is not therapy nor counseling.

These services do not include the practice of medicine or psychology or counseling. I, as a client, agree that I am fully responsible for my physical, mental and emotional well-being, including my choices and decisions while engaging in these services. If I am under the care of a mental health professional, I will make the mental health professional aware of my relationship with the Sexology Institute. If any type of counseling or mental health treatment is needed, the client is to be referred to individuals who provide that care.

I understand that for training and educational purposes, an intern will be conducting my session(s). An intern is a representative of the Sexology Institute who is training to become a sex coach, and that a function of my session(s) is for the educational benefit of the intern. The intern will be under the same obligations as a certified coach to maintain the confidentiality of my personal information.

I understand that information from my session will be shared by the intern with the Sexology Institute’s instructor for training consultation purposes and that identifying personal information will be held as confidential except as required by law.