Marital intimacy questionnaire

Name

First Name

Last Name

Email

How long have you been struggling with marital intimacy?

What methods have you used to try and fix these issues?

Have you been sexually abused or experienced sexual traumas?

Is your spouse trustworthy and safe?

What are you hoping to gain from this coaching mentorship?

Are you ready to invest your time, emotions, and finances into restoring this part of your marriage?

Is there anything else Sylvia should know about you before reviewing your application?

When would you like to start?