New Client Questionnaire

Name* This field is required.

First Name

Last Name

E-mail* This field is required.We will need this to get ahold of you!

How did you hear about Professional Cuddles?

Internet search

Facebook

AI Recomendation

Instagram

Business Card or Flyer

Met practitioner in person

Referral

Visited The Center (online or in person)

Attended an Event or Workshop

Podcast, News or Article

Other

Phone Number

Area Code

Phone Number

Gender (optional)How do you describe your gender?

Pronouns (optional)Do you have preferred pronouns?

Click here to take the Attachment Style quiz!

This opens a new tab.

Once you complete the quiz, come back and hit "Next"

(Please feel free to bypass the quiz as well)

Rank your Attachment Styles(Drag and Drop)

Click here to take the Love Language quiz!

This opens a new tab.

Once you complete the quiz, come back and hit "Next"

(Please feel free to bypass the quiz as well)

Rank your Love Languages(Drag and drop)

Areas I'd like supportWhat needs could you use help with? Select all that apply.

Human connection

Unconditional Love

Friendship/Community

Self Care/Self Love

Emotional support

Recognizing & Expressing my Needs

Acceptance & Belonging

Play, Joy & Laughter

Creative Expression

Sleep and Rest

Boundaries

Communication

Conflict Resolution

Emotional Intimacy

Physical Intimacy

Challenges and Life ExperiencesHelp us understand your unique circumstances. Select any that apply.

Anxiety

Depression

Trauma

Neurodivergence, including Autism or ADHD

Addiction

Post-Traumatic Stress Disorder (PTSD), or Complex PTSD (CPTSD)

Grief or Loss

Stress or Overwhelm

Loneliness or Isolation

Relationship Difficulties

Major Life Changes

Divorce

Burnout

Personality Disorder(s)

Other Mental Health Diagnoses

Please help us understand any Accessibility & Accommodation needs you may have:How can we make sessions accessible and comfortable for you? Select any that apply.

I use a wheelchair or mobility aid

I need step free access or a ramp

I need support with walking, balance or stairs

I need help with transferring or positioning

I am blind or have low vision

I am deaf or hard of hearing

I use sign language or another communication method

I need sensory accommodations

I struggle with chronic pain

I am immunocompromised

I use a service animal

Other

Please feel free to share any additional details and how we can best serve you:

If you have experience with other forms of support or therapy, please share a little about what you have explored so far:

Additional Services and OfferingsPlease select all that may interest you

Peer Support Groups

Cuddle Party Workshop

Social Events & Excursions

Companion Animal-Assisted Experiences

Group Learning

Educational Workshops

Before Proceeding:

Please be sure to read through our Client Agreement & Waiver.

You will need to sign this agreement before your first session, so please make sure you understand our policies before booking anything!

Got anything else you would like to ask or share?

For more information, please visit us at www.professionalcuddles.com

Thank you so much for filling out our new client questionnaire!

All that's left is to click SUBMIT!