Assessment

The first step in achieving a good Love Life is to help me help you. This starts when I understand your wants, needs and desires. By completing the assessment form below, you provide me with the necessary information needed to better serve you on your journey.

Even though some of these questions might seem unrelated- your mind, body and soul are all connected and each one plays a vital role in your sexuality. Having a heightened awareness in these three areas is a big step toward achieving your best love life.

I am so excited for your new journey toward a happy and healthy love life as you ignite the spark of self discovery to reveal your love style.

Note: Your completion of this assessment entitles you to a complimentary assessment phone call with me. During this phone call we will make formal introductions, get a feel for one another and decide about next steps.

ASSESSMENT FORM

Personal Details

* Indicates required field

Name *

First

Last

Email *

Age *

Sex *

Gender *

Sexual Orientation *

How did you find Katelyn? *

Relationship Details

Are you currently in a relationship? *

If yes, what type of relationship? *

How do you feel about the relationship? *

Does your partner know you are seeking love coaching? *

Sexual Details

How many times do you engage in sexual activity each week? *

Why are you seeking a love coach? *

What do you want to achieve from coaching? *

What intimate activities do you want to do but for whatever reason are unable to do? *

Why are you unable to take part in these sexual activities? *

What is your ideal sexual situation? *

What are your sexual turn-oﬀs and turn-ons? *

How does your sex life compare now to five years ago? *

If you view porn, what do you like most? *

Which part of porn do you fast forward to? *

Which part of porn do you skip? *

Wellness Details

What is your medical history? *

What medication are you currently taking? *

Have you previously had any Sex Therapy or other Mental Health Professional services? *

If so, when was your last treatment, what treatment was given and how did you feel about the outcome? *

Based on your treatment above, has this concern been ongoing or more gradual? *

What do you believe to be the cause for this concern? *

What do you need in your life to consider yourself sexually fulfilled or satisﬁed? *

What would that look like? *

Why do you long for this? *

Dietary and Fitness Details

How many days a week do you consume the following?

Fruits *

Vegetables *

Red Meat *

Fish *

Poultry *

Sweets *

Soda *

Dairy *

Coffee *

Fast Food *

Alcohol *

Recreational Drugs *

Tobacco *

What are some of your favorite foods? *

How many days a week do you exercise? *

Scheduling Details

What is your preferred time to have a quick phone call? *

Is there a preferred day of the week that works best for you? *

What is the best contact phone number number to reach you? *

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