Are you a high-achieving man who ever experiences guilt, shame, anxiety, or overthinking around sex or intimacy? *

Yes

Which outcome would have the biggest impact on your life right now? (Choose one) *

Enjoy sex with confidence, freedom, and ease

Feel confident and comfortable in my body

Build a healthy, fulfilling romantic relationship

Find clarity and peace with my sexual desires

Which of the following do you currently struggle with when it comes to sex or intimacy? (Choose all that apply) *

Overthinking or anxiety during sex

Religious guilt or purity culture-related shame

Difficulty getting or staying hard

Difficulty finishing when you want to

Body image concerns

Lack of confidence around sex or intimacy

Lack of clarity or peace with your sexual desires

Difficulty expressing your desires or boundaries

Building the kind of relationship or intimacy you want

What have you already tried to improve this area of your life? (Select all that apply) *

Therapy or counseling

Coaching or personal development programs

Books, podcasts, or self-help content

Prayer, faith-based guidance, or spiritual counseling

Talking with friends, partners, or trusted mentors

I've mostly tried to figure it out on my own

A combination of several of the above

I haven't seriously worked on this yet

Is working on this a priority for you at this point in your life? *

Yes, this is a priority

No, this is not a priority

Which statement best describes your financial readiness? *

I am ready and able to invest in solving this now.

I could invest if I feel confident this is the right solution.

I would need a plan or short time to prepare financially.

I am not in a position to invest in myself right now.

First Name *

Last Name *

Email *

Phone *

Where did you find this form? *

Instagram

Facebook

YouTube

TikTok

Email List

Other (Please specify in notes)

Notes - Is there anything else you would like me to know? (Optional)

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