Welcome

1
Name
First Name
Last Name
2
Phone Number
Area Code
Phone Number
3
Email
example@example.com
4
Gender Identity
5
Sexual Orientation
6
Pronouns
7
Location
8
Age
9
Why are you interested in working with Dr. Rikki? What is your intention and goal for seeking intimacy and/or relationship/dating coaching?
Huge
Large
Normal
Small
Ok
Ok
10
Relationship Status
11
Occupation
12
How do you currently manage stress and maintain your mental health?
Huge
Large
Normal
Small
Ok
Ok
13
Have you previously explored any therapies or practices related to relationship communication, sexuality or intimacy (e.g., counseling, somatic work, tantra)?
Huge
Large
Normal
Small
Ok
Ok
14
Are there any health concerns or disabilities that you feel may be affecting your sexual or relationship experiences?
Huge
Large
Normal
Small
Ok
Ok
15
On a scale of 1-10 how satisfied are you in your current relationship and or dating life?
16
How do you feel about your current communication patterns with partners regarding important topics, vulnerability, sex and intimacy?
Huge
Large
Normal
Small
Ok
Ok
17
How do you currently navigate conflict or disagreements in your relationships?
Huge
Large
Normal
Small
Ok
Ok
18
Describe your ideal relationship dynamic, including emotional, physical, and spiritual aspects.
Huge
Large
Normal
Small
Ok
Ok
19
On a scale of 1-10, how satisfied are you with your current sex life?
Huge
Large
Normal
Small
Ok
Ok
20
Describe your current sex life (frequency, quality, etc)
Huge
Large
Normal
Small
Ok
Ok
21
What is your current relationship to sex and your sexuality? What do you appreciate, what do you find challenging?
Huge
Large
Normal
Small
Ok
Ok
22
How do you envision your ideal sexual and intimate life?
Huge
Large
Normal
Small
Ok
Ok
23
Have you experienced any form of sexual dysfunction, trauma or discomfort? If comfortable, please share.
Huge
Large
Normal
Small
Ok
Ok
24
What motivated you to seek out this form of counseling/coaching?
Huge
Large
Normal
Small
Ok
Ok
25
Are there specific practices or areas (e.g., emotional intimacy, communication, sexual techniques, spiritual connection, tantra, dating, manifesting the one) you are particularly interested in exploring?
Huge
Large
Normal
Small
Ok
Ok
26
In what ways do you feel your current or past relationships could have benefited from better intimacy, communication or sexual connection?
Huge
Large
Normal
Small
Ok
Ok
27
Are there any fears, hesitations, or concerns you have about engaging in this therapy and coaching process?
Huge
Large
Normal
Small
Ok
Ok
28
Are you ready to commit both time and financially to sessions?
Huge
Large
Normal
Small
Ok
Ok
29
Do you have any specific preferences or requirements for session times (e.g., weekdays, evenings, weekends)?
Huge
Large
Normal
Small
Ok
Ok
30
How did you hear about my services?
Huge
Large
Normal
Small
Ok
Ok
31
Is there anything else you would like to share or think is important for me to know before our discovery call?
Huge
Large
Normal
Small
Ok
Ok
32
Instructions for Completion

Please take your time to answer these questions thoughtfully and thoroughly. Your responses will be kept confidential and are crucial for customizing our sessions to effectively meet your unique needs. Should you be chosen to proceed with my services, I will reach out to you within 5 business days to schedule a complimentary discovery call where we can explore the possibility of working together.
Should be Empty: