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Libby Sheppard
Bodyworker & Intimacy Coach
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Intake form
Coaching & Bodywork Intake Form
Before arranging coaching or bodywork sessions, I ask all prospective clients to complete this questionnaire. It helps me understand what brings you here, what you're hoping to achieve, and whether my experience and approach are a good fit for your needs. Please take a little time to consider your answers. I'm not looking for essays, but thoughtful, specific responses are much more helpful than one-word answers or general statements. Where possible, give specific examples of your experiences. Some questions are personal, and you're welcome to leave out anything you'd prefer to discuss privately. There are no right or wrong answers, and you don't need to have everything figured out before reaching out. Once I've reviewed your responses, I'll let you know whether I feel I can support you and, if so, suggest an appropriate next step. Your information will be handled confidentially in accordance with my privacy policy. Estimated completion time: 10–15 minutes.
Please enable JavaScript in your browser to complete this form.
Section 1: A little about you
Name
*
First
Last
Email
*
Date of birth
*
Format day/month/year
Gender
Which type of sessions are you interested in?
*
In-person bodywork and coaching
Virtual coaching
I'm open to either / would appreciate some guidance
If in-person, which is your preferred location?
Brighton
London
Stockholm
Is there anything about your current relationship circumstances, sexual orientation or identity that would be helpful for me to understand?
Section 2: What brings you here?
What has prompted you to seek coaching or bodywork at this particular time?
Which areas would you particularly like support with?
*
Sexual desire, libido or arousal
Erectile difficulties
Ejaculation or orgasm difficulties
Pain, discomfort or physical sensitivity
Sexual confidence, shame or body image
Intimacy, connection or communication
Masturbation, pornography or sexual habits
Understanding pleasure, touch or sexual anatomy
Exploring new experiences, sensations or aspects of sexuality
General curiosity, personal development or sexual wellbeing
Other (please specify below)
Select all that apply
Of the areas you've selected, which ONE feels most important to address first, and why?
What do you think might be contributing to the situation you're experiencing?
Section 3: Your relationship with sex, pleasure and your body
to your expectations
How would you describe your current relationship with your body and your sexuality?
How would you describe your current experiences of sexual pleasure and intimacy?
Are there any beliefs, expectations or habits around sex that you feel might be limiting your enjoyment or confidence?
Can you recall an experience of intimacy, pleasure or connection that felt particularly positive or satisfying?
Section 4: Your health, history and previous experiences
Have you previously sought support or tried anything to address the concerns you've described?
Are there any physical or mental health conditions, medications, injuries or recent life changes that might be relevant to our work?
Are there any difficult experiences, sensitivities, personal boundaries or concerns that you would like me to be aware of?
Section 5: Your goals and expectations
Imagine we've worked together for a few sessions and you've found the experience genuinely helpful. What would be different?
What specifically appeals to you about my approach to coaching and/or bodywork?
Is there anything you're unsure about, concerned about, or would particularly like me to know before we arrange an initial conversation?
Thank you for taking the time to complete this questionnaire.
I'll review your responses and get back to you to discuss whether my services are appropriate for your needs and, if so, how we might proceed.
I understand that coaching and bodywork are educational and supportive services, not substitutes for medical or psychological treatment. I understand that submitting this form does not guarantee acceptance as a client, and that any in-person touch will be discussed and agreed upon separately.
*
I agree
Submit