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Sexual History Intake


Please answer as many questions as you can, especially if seeking sex-specific therapy. Detail is not needed on this form, rather this will be used for an in-depth conversation in session to help with the treatment process.


All fluidity, expression, verbiage, history, orientation, etc. is accepted and celebrated at this practice.


*This practitioner is a mandatory reporter and as such, please be aware that thoughts of harming others or self are not reportable, though may result in further exploration and enactment of a safety plan. This is a safe space to talk about fantasies, desires, kink, BDSM, sexual exploration, open relationships, etc. The ACTUAL past or present ACTION or future INTENTION or PLAN to harm someone who is underaged, elderly, disabled, or considered unable to protect themselves will be reported to appropriate authorities to ensure the safety of all. Please feel free to ask any clarifying questions before proceeding. This office is not properly trained in sexual offenses and will refer to appropriate services if needed. Please acknowledge your understanding below:

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