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Welcome to Closeness. I know it took a lot for you to be here. You’ve come to the right place.

 Let’s get to know each other so that I can help you in the best way possible.

Please fill out each field to the best of your ability. To move to the next field press tab on a computer or tap the arrow or next field on your phone.  

If you don’t know an answer, take a moment to reflect on it.  If you  don’t feel comfortable answering, just leave it blank.  

Your answers are confidential and will not be shared with your partner without your consent. Consent  is located on the last page before you press submit.

 When applicable please have both partners fill it out.  

Congratulations, you just got the hardest part done, which is to actually reach out for help. 

Closeness Sex and intimacy intake form

4455 Murphy Canyon Road, 92123
San Diego CA

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