Application to Work with Me Name * First Name Last Name Email * Phone * (###) ### #### Location/Timezone * Occupation * Gender/Pronouns * Sexual Orientation * Relationship Status * What brings you to sex coaching at this time? * Have you worked with a sex coach or therapist? * Yes No What areas would you like to work on? Check all that apply. * Relational stuff Premature Ejaculation (PE) Erectile Dysfunction (ED) Desire/Arousal Challenges Body Image Performance Anxiety Exploration (kink, fantasies, etc.) Ethical Non-Monogamy (ENM) Male/Female Arc of Arousal Other If "Other" please explain Describe your current sexual relatonship with yourself. * Describe your current sexual relatonship with partner(s), if applicable. Describe any cultural, spiritual, or religious beliefs that may influence your experience of sexuality? Do you have any relevant medical conditions or medications that might affect your sexuality? I understand that sex coaching is not therapy or medical treatment and does not replace professional healthcare.Everything shared is confidential unless there is a risk of harm to myself or others. * Check Here to Consent Type Your Name Here to Sign * Thank you for your submission. I’ll be in touch within 48 hours.