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Welcome to Closeness

I’m San Diego’s top rated sex and intimacy coach. If you’re experiencing any challenges in your relationship or single life, you’ve come to the right place.

This is an optional form and each prompt is optional except for your contact information. If you wish to skip this form and schedule with me now, you can tap or click here.

This form is not shared with your partner. However, these subjects are likely to come up, so if there are any answers you prefer to keep private, please let me know on the last question on section four.

You are about get real help. I’m highly competent at making your session feel comfortable, safe and even exciting when appropriate. More information, including fees, podcast and reviews, can be found here. I look forward to meeting you!

CLOSENESS
Intake Form

Hello! What is your full name?

Email

Phone

Dates for your first appointment

Age

Together or by yourself?

Offspring

Describe your work

Your current sex drive

If applicable, how does it compare to your partners?

Time together if you're involved with someone

Sex work

What's working?

Sexual attraction to one another

How well do you communicate?

What are you struggling with?

How can I help?

Has there been betrayal on yours or their part?

In terms of getting these things taken care of, where are we?
CHECK ALL THAT APPLY

Last ditch effort It has been going on for a while but we haven’t addressed it I've been trying to address it with other professionals with little or no results I'm here to learn more about my body and how it works I am curious about reaching orgasm or other types of pleasure such as g-spot, a-spot, squirting or clitoral orgasms Things are great but I want to learn to be a better lover I would like you to show my partner how to excite me and get me going I would like you to help me get to know my body better, get out of my head and figure out what I want

Do you enjoy or love sex?

Sexual Intimacy other than sex

Do you wish there was more of this?

How often are you having sex?

Is lack of sex or too much sex a deal breaker?

Do you watch porn? How often?

How do you like to have sex initiated?

Being affectionate, soothing and loving

How often are you in touch with yourself?

You wanted to share more?

Do you think your strategies are effective at getting you what you want?

If you don't lean towards initiating sex, how does your partner know you're ready or want it or should make the move?

Expectations about sex

Meds, pills and drugs

Rejection

Initiation

Turning them on

Taking the lead and knowing how to do it

Communication

I would like my relationship to remain

Monogamous Open in some way I am open to anything I want to stay single and have fun I want my partner to only want me I am committed to my partner and love them but crave and want causal encounters or to have sex with others I’d like to get out of this relationship and need some help communicating this to my partner Other

Relationship with your parents

Religion

More details

Orgasm struggles with or without your partner?

Do you both reach orgasm regularly, even if not at the same time?

A little more

The female orgasm

Additional stimulation

Any restrictions on consent to discuss? Privacy and confidentiality

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Let's get started

CLOSENESS Intake Form

LISTEN TO CLOSENESS

EVERYWHERE PODCASTS CAN BE FOUND

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CLOSENESS
Intake Form