New Couples+ Client Intake Use this form to begin the process of working together. The more information you provide here, the more you'll get from our work together. One should be filled out for each person attending the sessionsI will be in touch shortly!IMPORTANT - Be sure to check the FAQs on my website before submitting. Name * First Name Last Name Pronouns * Email * Phone * Country (###) ### #### What service are you interested in? * Life Coaching Sex/Intimacy Coaching Relationship or Dating Coaching (individual) Couples+ Coaching Body Acceptance Coaching Consulting Mentoring Other How did you hear about me? * Friend Social Media Referral | Therapist, doctor, etc. Book Podcast/Radio Other Media Briefly describe what would you like to work on with me. Just a general hint is enough. (e.g. sexuality, pleasure, relationships, communication, desire, personal goals, career goals, life transitions, etc): * What approaches (if any) have you tried before to work through this? This could include; therapy, reading books, workshops, lectures, or coaching. * Of those things, what's been helpful? What's been unhelpful? What would have made the experience better for you? * What changes are you seekng to make? How do you want to feel? What are your hopes and expecations? What will a successful outcome or result look like for you? (You're also welcome to work with me for the process and the insight - not everyone is looking to meet goals or experience profound changes). It's good for us to be clear about this before we begin. * How will you know that coaching is succeeding? (ie what will others see you doing differently, or what will change in your life?) * Are you currently working with a therapist? Have you in the past? * I recognize you have options in choosing a professional coach to work with, (and I'm not your average coach.) I am very curious about you, and what matters to you in selecting a coach. What resonated for you about me/my work/my approach? Why have you selected me as someone who fits what you're seeking? * After reading about me and the FAQs, what hesitations do you have, if any, about working together at this time? How might you manage these? * Please indicate your affiliation with any of these communities/ identities/practices * LGBTQIA+ GNC/NB Trans BIPoC CNM/Poly Kink/BDSM SW Other Is there anything else you would like me to know about your identity, values, faith sexuality, etc. that may become relevant while working together? Is there any other information you'd like to share with me? * Thanks for completing the form. I see clients Mon-Fri, 9:00am - 3:00pm EST. Please let me know what days and times you might prefer and I will do my best to accommodate you. Once you complete this form, I will reach out to the email you provided with some available dates and times. If you have any questions, you can leave them below or, please feel free to reach out to: hello@ellechase.com. Thank you! I will reach out to the email you provided with some available dates and times. If you have any questions, you can leave them below or, please feel free to reach out to: hello@ellechase.com.
