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Pleasure Practice New Client Form

Please provide the following information and answer the questions below. If anything does not apply to you simply write N/A or leave blank. Feel free to skip any questions you are not comfortable answering or place a star next to anything you would like to talk about but do not want to write down.

Personal Information

Emergency Contact

Pleasure Practice


The Process

Sex and Relationship coaching can be helpful in improving overall health, wellbeing, and quality of life. Engagement in services is a collaborative process that requires a significant commitment of time and energy. Progress depends on many factors, including the nature and severity of the problems being addressed, life circumstances, and motivation. Regular meetings over time, as recommended by Nicole, in addition to following through with recommendations of Nicole will lead to the greatest chances of achieving your treatment goals. Coaching works best when you are willing to share openly and explore with Nicole the feelings, thoughts, and experiences that arise over the course of our work together. This includes what you have noticed about the progress of your sex/relationships, feedback for Nicole around what is and is not working and what you would like more of, and any concerns you may have about our work together. At times, this may involve pushing your comfort zone, but generally results in better outcomes and a greater connection and alliance with Nicole.

Payment Method

Credit card information will be retained by the Pleasure Practice. You will only be charged at the time of service.

Thank you for providing your information. We will explore your responses these questions during your first session. Please reach out should you have any questions.

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