Please fill out the Questionnaire before your first Session. It will help me gain a better knowledge of you and how I can support you, and it will help you gain more understanding of what you need as well as feel more supported by me.

Please copy and paste into a word document and send to me as an attachment, or copy right into an email.

You may also request that I send this to you in an email.

Some questions you may not understand. You are welcome to email me to ask me to explain further, or we can go over this when we meet in person. If you cannot answer all of the questions now, it is ok. Just do the best you can. When you have completed the form, please email it to me or bring it with you to your scheduled session.

Take care, and I look forward to seeing you soon!honesty

Asttarte. Sex, Relationship, Intimacy, Spiritual or Life Coaching

(To be filled out by all new clients) This form and all information obtained from it are kept in strict confidence and honored as an essential step in a relationship between client and Practitioner. No information will be shared from this form or from experiential sessions. You will not be contacted at your home, but if you wish e-mails may be sent to you for promotions or to discuss appointments. All correspondence is confidential.

Please email this form to me at






1). What are your goals in working with a Coach? Are you interested in Life, Relationship, Sex, Spiritual or Family Coaching?

2). What do you know about Life Coaching and what do you expect to get out of the Sessions? (Are you aware Coaching Sessions can be done over the phone, through email, or in person and are not a Healing or Therapy Session?)

3). Are you interested in phone Coaching, Group Coaching, Laser Coaching, email Coaching or in person Coaching?

4). What is the Relationship you are seeking to improve? (The relationship with yourself, your Spirituality, your Sexuality, your partner, your parents, children, parents, work, your health, or other?)

5). When you make a plan to attain a goal, are you someone who generally sticks with them, or do you forget and let other things take precedence?

6) If you are interested in Relationship Coaching, what is your current relationship status? If you are in a relationship, please describe the relationship(s) and how you feel about them.

7). How well do you follow directions? Do you rebell and do what you want, or do you take advice or suggestions from others well?

8). Are you able to stick to appointments, or do you have a lifestyle where you need to make changes often?

9). How do you feel about your relationship with yourself?

10). Please describe what is most important to you about your current relationship, or a previous relationship.

11). When it comes to communicating your feelings, do you feel that you are able to communicate effectively? Do you feel that what you say is being heard by the people that matter most to you? Where do you feel are your blocks to communication?

12). Do you have any history of abuse?

13). What do you feel are the biggest issues in your current relationship, or the most recent relationship that had the most significance to you?

14). If you are in a current relationship, what are your deepest desires in this relationship? What are your goals and what are you committed to in this relationship? (Note: If you are currently receiving help with a therapist, please do not stop even if you feel your work with me is powerfully effective and helpful.)

Thank you for taking the time to fill out this form. It is very appreciated and is an important step in your growth. Namaste!


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