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
First Name
Last Name
Partner A: Email
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?)
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.)
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.)
What does thriving look like for you as a couple?(This can be playful, sensual, spiritual, or grounded—however you dream it.)
💖 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?
Partner A
Partner B
What do you most desire to feel in your relationship?
Partner A
Partner B
On a scale of 1–5, how ready do you feel to begin this journey together?(1 = hesitant / unsure, 5 = completely ready)
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.)
Submit
Should be Empty: