Intake form for 1:1 Sessions

Hey! I’m really looking forward to connecting with you soon.

Before our session, please fill out the form below to give me a glimpse of who you are and what you’d like to focus on during our time together.

This form not only helps me prepare for our upcoming session, it’s also an opportunity for you to reflect and bring attention to what you’d like to dive into during our call.

Feel free to share as much as you feel comfortable with and please be as specific as possible. There are no wrong answers, just be as honest as you can—even if it means you’re not sure how to answer.

Please have this form filled out at least 24 hours before our session.

*Note: All information and responses will be seen by my (Ev’Yan) eyes only.

Name

First Name

Last Name

Pronouns

Give me a quick glimpse of the relationship you have with your sexuality.

Now tell me a bit about the relationship you currently have with your body/sensuality.

What would you say is your priority focus for our session?

What's something else that you'd really like to dive into if we have time?

If you could have it your way, how would you want your sexuality/body relationship to look + feel like?

Allow yourself to dream here, even if it doesn't seem possible.

What do you think is getting in the way of you having this experience with your sexuality/body?

How would you like me to help?

Have you ever been in therapy before?

Yes

Are there any other physical, emotional, or mental, or spiritual moments that have shaped and impacted your sexuality/body? Any particular experiences that are useful for me to understand going into our session?

What support systems do you have currently in your life that'll help you integrate what we uncover during our session?

i.e., therapy, group spaces, loved ones or chosen family you can discuss/be in practice with.

Anything else you'd like me to know?

*All information and responses will be seen by my (Ev’Yan) eyes only.