Preparation Consultation Questionnaire
Thank you in advance for your honesty, we take your privacy seriously, and these answers will ONLY be used to provide the best, personally tailored service for you!
Name
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First Name
Last Name
Email
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example@example.com
Mobile Phone Number
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How comfortable are you to talk openly about your sexual/intimate life? (1-10) Why did you choose that number?
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How informed are you about female/male anatomy, specifically about names, function, and interaction? (1-10) Why did you choose that number?
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How satisfied are you with your sexual/intimate life? (1-10)Why did you choose that value?
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Is there ONE particular thing, that if added to your sexual/intimacy life, would take your satisfaction level to a 10 or even higher? Why/Why not?
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Are you willing to do the work to add that thing to your sexual/intimacy life now? Why/Why not?
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What do you feel is one of your biggest strengths in your sexual/intimate life? Why did you choose that? How strong is it? (1-10) Why did you choose that number?
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Are you glad that is your biggest strength? Why/why not?
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Is there another strength you would prefer to be bigger? (If no please put NA and, skip to the next question) If yes, What is it, and why would you prefer it?
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Is there another aspect of your sexual/intimate life that you feel is particularly good/strong? Why do you think that?
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Are you glad that is a strength? Why/why not?
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Is there anything else you would like to add to your sexual/intimate life? Why would this be a benefit?
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How much pleasure do you get from your sexual/intimate life? (1-10) Why did you choose that number?
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Do you believe you can have more pleasure? Why/Why not?
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Do you believe other women have more pleasure than you? Why/Why not?
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Have you had an orgasm before? (Yes, No, Unsure)
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Have you had an orgasm with a partner before? (Yes, No, Unsure)
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Have you had a penetrative orgasm before (vaginal or anal)? (Yes, No, Unsure)
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How easily do you rate your ability to have an orgasm? (1-10)? Why did you choose that number? (N/A if you have not had an orgasm before).
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Are you muti-orgasmic? Meaning, do you regularly have 3 or more orgasms during a sexual/intimacy encounter with another person or alone with yourself?
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Do you have a regular sexual partner? If yes, How often do you have sex with them? If no, How often do you have sex with a partner?
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If you have a regular partner, are you satisfied with the quantity/frequency of sex/intimacy with them? Why/Why not?
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If you have a regular partner, are you satisfied with the quality of sex/intimacy with them? Why/Why not?
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If you have a regular partner, are they satisfied with the quantity/frequency of sex/intimacy? Why do you say that?
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If you have a regular partner, are they satisfied with the quality of sex/intimacy? Why do you say that?
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Would you like to have sex more often? Less often? Is the frequency just right? Why/Why not?
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If you do not have a regular partner do you want one? Why do you say that?
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Do you have an ideal sexual/intimacy life that you believen would make your life in this area a 10 or better? If yes, please describe it below in 4 sentences or less:
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Regardless of having a partner or not, do you play/pleasure yourself alone? If yes, how often? (Or N/A)
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If yes, are you satisfied with your solo play/pleasure? Why do you say that? (Or N/A)
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If no, is there any particular reason why you dont? (Or N/A)
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How high do you feel your sexual/intimacy desire is? (1-10) Why did you choose that number?
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Are you satisfied with that number? Why/Why not?
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As you think back on the last twelve months: Did you have as much sexual/intimacy time/frequency as you wanted? Why/Why not?
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Did you have as much sexual/intimacy pleasure as you wanted? Why/Why not?
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Do you have any specific sexual/intimacy challenges that you want to overcome? Why/Why not?
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Please list any sexual/intimacy challenges you would like to overcome here. Beside each, give a number (1-10) how big a challenge it is for you. For example, they can all be a challenge value of 5 or all 8's, or all 10's or each can be a different value: (Note: it is ok to have, one challenge, several challenges, or zero challenges).
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Are there any emotional issues associated with your sexual/intimacy life that you are aware of? Please list those emotional issues here. Beside each, give a number (1-10) how strong an emotion it is for you. For example, they can all be a value of 5 or all 8's, or all 10's or each can be a different value:
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If yes to challeneges/emotional issues, are you currently seeing a professional to address them? If yes, may we contact that professional to integrate our services for your best benefit? (You will need to sign a release) Why/Why not?
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Have you seen a professional for any sexual/intimacy issues in the past? (Yes/No)
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Did you have a satisfactory outcome with their services? (Yes/No)
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Have you been released from their care? (Yes/No)
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Do you have any current physical health challenges that impact your sexual/intimacy life that we need to be aware of? Please list them briefly below in one sentence or less for each:
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Is there anything not covered in this questionnaire that you feel is important that WE be aware of to help you have the best possible outcome?
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Are you ready to do whatever it takes, to be ruthless and unmerciful, and to have a take-no-prisoners attitude against whatever is holding you back from having your best possible sexual/intimacy life? Why/Why not?*
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Are you willing to commit up to 1 hour nightly for homework, every night, to achieve your best possible sexual/intimacy life? Why/Why not?
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Do you have a particular coaching style that is most effective with you? (Yes, No, Unsure) In one or two sentences, please describe that style, if you know it (or N/A):
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If we provide a great service to you, are you willing to provide a testimony (kept anonymous of course) that we can share with other women like yourself, to help them choose whether to use our services or not? Why/Why not?
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If we provide a great service to you, are you willing to tell your female friends about your great experience with us, and to refer them to us, so they can have their own great experience as well? Why/Why not?
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Is there any reason you cannot use our services today/this week?
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Submit
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