What childhood messages about sex/sexuality did you receive? Of those, how might they affect your sexuality today? *
What are any concerns you may have about your periods or pregnancy? *
What are any concerns you may have about being pre-/ peri-/ post-menopausal?
What have been your experiences with achieving orgasm? When alone? With a partner? Any difficulties? Positive experience? *
What have been your experiences with self-pleasuring or masturbating yourself? *
What is your present pattern and frequency for self-pleasuring/ masturbation? *
Describe the history of your sexual relationships: (talk about the number of partners, what sexual activities you have experienced, and the issues and conflicts that have emerged for you in intimate relationships.)
*
Describe the history of your sexual relationships: (talk about the number of partners, what sexual activities you have experienced, and the issues and conflicts that have emerged for you in intimate relationships.)
*
Describe your present sexual interactions, such as intercourse or masturbation, turn-on’s, your present pattern for sexual pleasure, how often, your current number of partners, etc.:
How often do you think about or desire to have sex? *
Check below or highlight any of these which are sexual “turn-on’s” for you: (Choose all that apply) *
Are you currently seeing a psychologist/therapist or body worker? *
Do you feel you need or may want a referral to a psychologist/therapist or body worker? *
Do you have any pre-existing medical conditions that may affect your sexuality? (For example, diabetes, hypertension, heart disease, depression...) If yes, please name *
Are you currently taking any prescribed medications, such as for hypertension, diabetes, depression, anxiety or cardiovascular disease? If yes, please write down the names of the medications. *
Do you feel confident in your knowledge about your body’s sexual anatomy and functioning? Are there areas about your body and/or your sexual functioning that you have questions about?
Are you interested in using safe, natural products that can enhance your sexual experience? *
What are your long-term sexual goals?
*
What is your primary goal for our work together? The main reason you reached out for coaching. *
Are you willing to commit to your sexual success, do you agree to do the assignments and allow yourself to your sexual pleasure? *
I hereby release Nicole Buratti, CWHC for any damages that may result from sexual coaching: *
Write here anything else related to your past or present experiences. Include anything that may be important for me to know, so that I may assist you toward reaching your sexual goals:
