Somatic Intimacy Coaching Intake for Couples
Complete this form together before your Discovery Call to help us co-create a powerful session aligned with your relationship desires and goals. There are a few places for individual reflection too—this will help me hold space for both of your unique voices and shared intentions.
Partner A: Name
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First Name
Last Name
Partner A: Email
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example@example.com
Partner A: Phone Number
*
Please enter a valid phone number.
Partner B: Name
*
First Name
Last Name
Partner B: Email
*
example@example.com
Partner B: Phone Number
*
Please enter a valid phone number.
What inspired you to seek out Somatic Intimacy Coaching together? (What’s currently calling you into this work as a couple?)
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How would you describe the current state of your intimate connection (emotional, physical, spiritual)? (Share from a place of honesty, there’s no judgment here, only curiosity.)
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What are 2-3 shared goals you have for your relationship right now? (These might relate to communication, sexual intimacy, trust, connection, or anything that matters to you.)
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What does thriving look like for you as a couple? (This can be playful, sensual, spiritual, or grounded, however you dream it.)
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Individual Insights
(Please have each partner respond individually to these two prompts)
What is one personal pattern or challenge you feel is affecting the relationship?
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Partner A
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Partner B
What do you most desire to feel in your relationship?
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Partner A
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Partner B
On a scale of 1-5, how ready do you feel to begin this journey together? (1 = hesitant / unsure, 5 = completely ready)
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1
2
3
4
5
1 is , 5 is
Is there anything else you’d like to share with me before our call?(This could be hopes, concerns, or anything you want me to know as we prepare.)
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Submit
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