Intake QUESTIONNAIRE Please complete the questions to the best of your ability. If there is something you want to talk about in person you can write that in the form. Name * First Name Last Name Email * Age Pronouns What would you like to work on together? How would you like to feel when we complete our work together? What would you like to tell me about your current intimate relationship/s? What else would you like me to know about your sexual history or current desire patterns, including gender identity, sexual orientation(s), self-pleasuring practices, fantasies, use of pornography, or any other information that you feel may be important for me to know? Do you have any health conditions or physical limitations that may impact your coaching sessions? Are you currently taking any medications that may influence your sexual experiences or coaching process? Have you had any previous experience with coaching or therapy? If yes, please describe your experience and what was helpful or not helpful for you. Are there any particular topics or activities that you are uncomfortable discussing or exploring during coaching sessions? Do you have any specific boundaries or limitations that you would like to establish for the coaching process? Is there any other information about yourself that you think is important for me to know before starting the sessions? I understand that many different feelings and thoughts can occur throughout the coaching process, all of which are welcome during sessions. I know that Kat is not a therapist and I will seek appropriate care from a qualified professional, if I need it. * I agree that I will be an active participant in my change process. * I have stated all medical conditions that I am aware of and will update Kat on any changes in my health status. * I understand that payment for each session is due by the start of the session. If I cancel a session with less than 24 hours notice, I agree to pay Kat the regular fee. * I am over 18 years old. * Thank you!