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Libby Sheppard
Bodyworker & Intimacy Coach
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Intake form
Intake Form
Provide only the contact details you’re comfortable with me using to send information to, and complete as many fields as you are comfortable to at this stage. PLEASE ENSURE THAT YOU ALSO SEND AN ACTUAL ENQUIRY EMAIL TO LIBBY@SEXCOACHINGUK.COM.
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Name
*
First
Last
Email
*
Date of birth
Please enter as DD-MM-YYYY
Gender
Sexual orientation
Gender of current partner(s)
Relationship(s) status
I heard about your services through/keywords I searched for were:
*
The reason(s) I am interested in Intimacy Coaching session(s) is/are:
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e.g. what prompted you to enquire, is there a specific intention you’d like to work with, issue you’d like to address or aspect of your sexual experience you would like to work on changing? Please give a brief outline…
I am interested in booking
*
In-person bodywork sessions in London or Stockholm
Virtual coaching sessions via Zoom
Online courses
Currently I am experiencing:
Lack of arousal
Sexual boredom
Erectile difficulty
Pain during intercourse
Inability to sexually satisfy my partner
Reliance on troublesome fantasies or turn-ons
Delayed or rapid ejaculation
Vaginal dryness
Difficulty achieving orgasm
Lack of genital sensation
Inability to sexually satisfy myself
Poor body image
Inability to communicate my sexual needs
Fears around sexual contact or activities
Decreased sense of connection with partner
Other
Check all that apply
Have you sought medical advice or been treated by a doctor for any of the above? Please detail:
Briefly describe your attitudes, thoughts, feelings, or perceptions about your body:
Briefly describe your attitudes, thoughts, feelings, or perceptions about sex (inc. oral and anal sex):
Briefly describe your attitudes, thoughts, feelings, or perceptions about orgasm:
Briefly describe your attitudes, thoughts, feelings, or perceptions about masturbation:
Briefly describe your attitudes, thoughts, feelings, or perceptions about porn:
Briefly describe your attitudes, thoughts, feelings, or perceptions about sex toys:
Briefly describe your attitudes, thoughts, feelings, or perceptions about sexual role-play & sexual fantasies:
What is your sex life like now? What would make it better?
Describe your most satisfying or exciting erotic/sexual experience? What made it so satisfying/exciting for you?
Please select all that apply:
I'm currently in a relationship and my partner knows I am seeking coaching sessions
I'm currently in a relationship and my partner does not know I am seeking coaching sessions
I'm currently in a relationship and would be interested in including my partner in the process
I'm currently in a relationship and am not interested in including my partner in the process
I'm currently in a relationship and I think my partner would be interested in being included in the process
I'm currently in a relationship and I think my partner would not be interested in being included in the process
Here are some examples of what clients at times want to work on, but the list is nearly endless, and I also work with non-sexual or body related issues. Tick any of the following that may be of interest to you, or tell me about your objectives in the box marked ‘Other’:
Understanding my body
Understanding my partner's body
Experiencing energetic alternatives to ejaculation
Experiencing G-spot, vaginal and cervical orgasms
Communicating my needs and desires
Connecting with a partner
Self/partner genital massage techniques
Increasing sexual satisfaction
Learning about/exploring my genital anatomy
Becoming more comfortable with my body
Techniques for full-body massage (self/other)
Moving beyond sexual fantasy
Experiencing arousal in a relaxed state
Ejaculation control/lasting longer in bed
Building intimacy with a partner/alternatives to penetrative sex
Masturbation coaching
Learning about/exploring my anus/prostate
Using sex toys
Working with genital scar tissue
Other (please describe in the box below)
Other:
Difficult things I want you to know about my sexual history are:
Wonderful things I want you to know about my sexual history are:
Tell me about your experience with counselling, coaching or bodywork, if any. What was helpful or least helpful?
e.g. sessions with...personal fitness trainer, psychotherapist, CBT practitioner, erotic bodywork experience such as sexological bodyworker, sensual massage, sex worker, surrogate, tantrika, other, Rolfing bodywork, deep tissue massage, reiki etc.
Please select all that apply:
I consume alcohol
I use recreational drugs
I use prescribed drugs
I am a smoker
I have an active lifestyle
I have a sedentary lifestyle
Your learning objectives for the first 3-5 sessions might be:
*
e.g. the area(s) of learning/growth that you want to focus on first. What will feel/be different after these sessions?
Please add anything else you think it is important for me to know:
Submit