Initial Intake - Dr. Michelle Fynan, PhD, LMHC - Counselor and Sex Therapist in Florida

Name

First Last

Gender

Age

What do you do for a living?

What is your relationship status?

Single

In a relationship

It's complicated

Married

Other

On a scale of 1-10, what is your level of happiness with your current relationship status (or lack there of...)?

When it comes to finding love or being in a relationship, what are your biggest challenges?

I'm attracting the wrong ones.

I'm attracting the people I'm interested in, but they don't end up wanting to continue dating.

I'm attracting the right people, and having relationships with them, but they are never long term.

I'm in a long term relationship, but we don't communicate well.

I'm in a long term relationship, but we aren't in sync in the bedroom.

I just got out of a long term relationship and there are things I want to work on before getting into a new relationship.

I am successful in my career but not so much in my love life.

I'm successful in life and love, but I'm interested in adding more heat between the sheets!

Other

What have you tried thus far?

Therapy (1-6 sessions)

Therapy (6+ sessions)

Relationship Coaching (1-6 sessions)

Relationship Coaching (6+ sessions)

Couples Counseling/Coaching

Sex Therapy

I haven't tried any of these options yet.

Other

What type of support would you be interested in? *

1:1 Virtual Relationship Coaching

Virtual Couples Coaching

In Person Couples Retreats

In Person Singles Retreats

Ladies Only Virtual Group Coaching

Virtual Sex Therapy

Getting to Know You