Your name, pronouns & location (city/ state, time zone):

What is your main present issue? What is the reason you are seeking support? Please be specific.

How long have you had this issue? How long has this been going on?

What treatments, movement, therapy, medications have you tried and when? What has helped, what has not helped? Please list current & past.

What other areas of your life are impacted by this issue?

Do you have any recent surgeries, persistent health issues, or physical limitations? Describe.

Are you currently pregnant or do you have any previous pregnancies (with any pertinent details- I’m asking so I can better understand potential influences on your pelvic floor, pelvis & emotional wellness)?

Are you currently seeing a pelvic floor therapist? If so, how long?

Do you have yoga experience? Please explain the extent of your yoga experience.

Do you exercise? If yes, what do you do and how often?

Rate your general body awareness on a scale from 1-10 where

1 = I feel completely numb & disconnected from my body  -->

10 = I have deep sensory perception, and feel very in-tune with my body

What is your personal philosophy for your health? I.e. what does it mean to be healthy and to take good care of yourself & is this important to you?

Are you in a serious relationship? If so, how long?

Would you describe your partner as supportive of your personal, individual growth (or, does your partner feel threatened by, make fun of, feel rejected by, or respond in any other way that prevents you from feeling totally free to evolve & grow)? 

What type of work do you do?

What do you hope to get out of your experience with yoga for sexual wellness? What are your personal goals?

What will help you know if we are succeeding at the work we do together?

Is there anything else you would like to share about yourself so that I may better support you?