Section 1: Basic Information
Partner 1
Full Name
What is the name of your partner if you're both submitting intake forms for coaching?
Email
Phone Number (for reminders/emergency contact only)
Time zone
Preferred Pronouns
If Other, please describe
2. What type(s) of cancer have you or your partner experienced?
3. What side effects, physical changes, or ongoing challenges are you or your partner navigating (e.g. pain, fatigue, neuropathy, sexual function, body image, etc.)?
4. Are there any current or upcoming medical procedures that may affect our work together?
Section 3: Your Relationship
5. How long have you been together?
6. What are some strengths in your relationship?
If Other, please describe
Please add a brief description
Section 4: Intimacy & Pleasure
9. How would you describe your current intimacy (physical or emotional)?
10. What does “pleasure” mean to you right now?
11. What are you most hoping to get out of this coaching experience?
12. Are there any topics that feel off-limits or sensitive that I should be aware of?
Section 5: Accessibility & Support
13. Are there any access needs, physical accommodations, or preferences I should know about to support your comfort?
14. Is there anything else you’d like me to know before we begin?
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