Private Client Questionnaire Leave a Comment / By umaramin.edu@gmail.com / May 10, 2025 Before We Begin This private intake is your first step into a space that values discernment, depth, and devotion. There are no right answers—only honest ones. Take a few quiet moments to respond in a way that feels true. Your responses are seen only by me, and they help reveal whether this experience is meant for us to share. 1. What best describes your current experience with intimacy? I feel disconnected and unsure how to fix it I’ve had fulfilling experiences but want deeper connection I’m very experienced but something is missing I’m unsure how to even begin talking about intimacy None 2. Which of these outcomes would feel like success for you? More confidence and skill with partners Feeling sexually alive and powerful again Healing emotional blocks around intimacy All of the above None 3. What best describes your level of commitment to this work? I’m just browsing or curious I’m interested, but I’m not ready to invest yet I’m ready to invest time, energy, and money to transform this part of my life I’ve been looking for someone like you and I’m ready to begin None 4. Which of the following most closely reflects what you’re willing to invest in your growth in this area? I’m hoping for free or low-cost support only I could manage up to $200/month I’m ready for coaching in the $500–$2,000/month range I’m ready to invest $3,000+ in deep, private work None 5. What have you spent money on in the past to improve your personal life, dating, or intimacy? (Select all that apply) Therapy Dating coaches or relationship courses Tantra, somatic work, or retreats None yet—but I know I need to 6. What made you curious about working with me? 7. What patterns or struggles are you done tolerating? 8. If our work together were a huge success, how would your intimate life look and feel in 6 months? 9. Is there anything I should know about you before we speak? Thankyou For Participating. If what you shared resonates, I’d love to stay connected. Please leave your details below to receive discreet updates, exclusive offers, and to explore whether we’re aligned to work together. Name Email Phone Time's up
