Your Intimacy & Connection Assessment
Please fill this out to help me understand how compatible we are.
Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which of these feels most like your situation right now?
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I'm in a relationship but feel disconnected from my partner
I've never fully explored or understood my own sensuality
Both feel true for me
Something else — I'll explain on the call
Q1 — How satisfied are you with the level of physical touch and closeness in your life right now?
Completely Starved
1
2
3
4
5
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7
8
9
Fully Satisfied
10
1 is Completely Starved, 10 is Fully Satisfied
Q2 — How freely can you acknowledge and own your desires — to yourself and to others — without shame or guilt?
total shame, can't admit it
1
2
3
4
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7
8
9
own it without apology
10
1 is total shame, can't admit it, 10 is own it without apology
Q3 — How emotionally and physically close do you feel to the most important person in your life right now?
Completely disconnected
1
2
3
4
5
6
7
8
9
Deeply connected
10
1 is Completely disconnected, 10 is Deeply connected
Q4 — How well do you know and understand your own sensual and sexual self?
No self-knowledge here
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2
3
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7
8
9
Deeply self-aware"
10
1 is No self-knowledge here, 10 is Deeply self-aware"
Q5 — How ready are you to actually do something about this — not just think about it, but take real action?
Not ready at all
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2
3
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5
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7
8
9
All in — done waiting
10
1 is Not ready at all, 10 is All in — done waiting
In your own words — what is the one thing you most want to change or experience in the next 6-12 months?
"Don't overthink it. Just say what's true."
Score
What's your biggest concern about getting support with this?
I'm not sure it's safe to talk about this openly
I don't know if anything can actually change
Cost or investment
What my partner or others would think
I don't have any concerns — I'm ready
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