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What are your Intimacy Levels?
Please complete this Intimacy Transformation Chart to assess and help understand your current intimacy dynamics. Your response will create a personalized report that will be sent to your email.
16
Questions
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1
Name
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Your responses will be used for a case study. Information is for purposes of identifying proof that you are a real person.
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2
Rate Your Physical Intimacy Levels
Embracing
,
Hugging, kissing, massages, touching, cuddling, caressing, holding hands, sitting close
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Little to None
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3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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3
Rate Your Sexual Intimacy Levels
Sensual satisfaction, arousal, fantasy /desires, physical indulgence, vulnerable
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Little to None
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3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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4
Rate Your Social Intimacy Levels
Appearances at Social, public, private events, seen as a couple or invited out with other couples
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Little to None
Off the Chart
3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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5
Rate Your Intellectual Intimacy Levels
Meaningful conversation, reading, talking, learning, shared values, and and interest together
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Little to None
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3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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6
Rate Your Recreational Intimacy Levels
outdoor activity, engagement, fun, leisure, sharing the same hobbies and interests
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Little to None
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3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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7
Rate Your Creative Intimacy Levels
Creatively collaborate on projects, crafts, fixing or repairing, creating original works like Cricut, art, woodwork, painting, crafts, decorating, etc.
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Little to None
Off the Charts
3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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8
Rate Your Spiritual Intimacy Levels
Shared philosophies, Respect for each other’s spiritual belief’s, shared purpose, spiritual support, nurtures each other’s inner peace
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Little to None
Off the Charts
3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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9
Rate Your Aesthetics Intimacy Levels
sharing beautiful experiences, music, art, nature, theater, sunsets, beach, star gazing, etc
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2
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5
Little to None
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3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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10
Rate Your Conflict Intimacy Levels
able to work through disagreements, talk through arguments, face issues head on, able to express dissatisfaction in the relationship
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Little to None
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3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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11
Rate Your Emotional Intimacy Levels
Sharing significant feelings, Affirming, caring, deeply touching and showing Interest in each others feelings
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Little to None
Off the Charts
3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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12
Rate Your Crisis Intimacy Levels
Standing together, hardship, being able to solve issues together and work as a team comfort each other in times of distress
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2
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Little to None
Off the Charts
3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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13
Rate Your Work Intimacy Levels
working together as a couple, parenting, shared responsibility, shared contributions, building & creating stability & harmony in the home
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Little to None
Off the Charts
3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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14
Overall, How would you score your Communication Intimacy Levels?
openly able to express feelings, emotions, needs, wants and thoughts
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Have trouble expressing
Openly Talk About Everything
3 represents a neutral position. Please choose between 2 or 4 to help provide a better accuracy for results.
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15
Now, where should we send your results?
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16
Instagram Username and-or phone number
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