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Intake Form Questions

Welcome to Intima Collective.

We're excited you're here. This intake form will help us get a clear sense of where you are emotionally and relationally, so we can guide you toward the best experience. Take your time, answer honestly — there’s no judgment here.

Let’s get started, love.

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Relationship Status

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Do you have children

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Are you Currently Co-parenting

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Occupation

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Work Schedule

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What drew you to Intima Collective

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What are your biggest challenges in relationships right now

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When conflict arises, I usually...

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Which emotional patterns do you recognize in yourself (choose all that apply)

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Which emotional patterns do you recognize in yourself (choose all that apply)

Overthinking

Shutting down emotionally

People-pleasing

Escape or numbing

Avoiding vulnerability

Struggling to express anger in health ways

Struggling to receive love/compliments

Have you ever worked with a therapist, or counselor before?

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What are you hoping to gain from this experience?

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How would you rate your current emotional self-awareness?

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How would you rate your current emotional self-awareness?

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What's your preferred learning style? (choose all that apply)

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What's your preferred learning style? (choose all that apply)

Self-paced reading

Listening to audio

Interactive workshops

One-on-one conversations

Is there anything else you'd like us to know about you before we begin?

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