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Assessment Elite Intimacy Individual (Female)
What is your full name?
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What is your email address?
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What is your phone number?
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What would you say is your primary reason for reaching out?
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How would you know the work we do together would be working? What is your metric for success in this area? (ex - I would feel more free in my body and enjoy sex more)
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What resources have you explored to help in this area? (Therapy, Coaching, Workshops, Books, Podcasts)
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What patterns have you noticed about yourself that are getting in the way of what you want?
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How would you describe where you are with relationships?
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Single
Dating
Committed Relationship
Married
Heterosexual
I'm bisexual
LGBTQA+
My partner is bisexual
Couple
Trouple
Quad+
Other
If in a relationship, for how long have you been together?
How would you describe your relationship with sex?
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When emotionally triggered, what do you tend to do?
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Withdrawl
Try to sooth it
Try to fix it
Become defensive
Critisize
Shut Down Sexually
Get angry
Cry
Seek reassurance
Other
How comfortable are you with being emotionally available to a partner? (10 being the most available)
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0
1
2
3
4
5
6
7
8
9
10
Which attachment style best describes you?
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Secure
Anxious
Avoidant
Disorganized (both)
I don't know what this is
Which relational pattern best describes your relationship during conflict?
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Pursuer then withdraws
Pursues until its resolved
Withdraws until it blows over
Avoidance
Healthy repair
Unsure
What part of any trauma has an impact on your life now?
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I processed most of it, have awareness, and have tools to self regulate
I could use some help in processing some parts
I haven't even scratched the surface and feel scared to open that up
I don't believe I've had trauma
I don't want to talk about it
I noticed it still directly impacts my life
I've done alot of work to correct alot but could still use some help
How satisfied are you with your current sex life? (10 being the most satisfied)
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0
1
2
3
4
5
6
7
8
9
10
What would you like to see improved in your sex life?
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Describe your relationship with spirituality or religion and what role it plays in your life?
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Have you heard of Tantra before?
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Yes, I am familar.
Kind of
No, I have no idea what it is.
Other
Which one of these areas that I cover stand out as something you'd like to learn?
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Raising emotional intelligence and self-awareness
Resolving trauma based relationship patterns
Rewiring attraction towards emotionally safe partners
Nervous system regulation
Sexual mastery breath work
Somatic release of stored stress and emotional tension
Installing a new communication models
Active listening and validation
Navigating difficult conversations around intimacy
Increasing emotional safety
Developing calm grounded leadership
Becoming more decisive an intentional
Understanding masculine and feminine dynamics
Understanding your partners emotional needs
Increasing emotional attunement
Rebuilding trust after a rupture
Turning friendship Dynamics into romantic lover energy
Creating meaningful rituals of connection
Learn how to authentically and safely increase pleasure
Learn tantra inspired intimacy practices
Learn how to have boundaries in a healthy relationship
Is there anything else you would like me to know before we begin working together?
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Submit
