Apostolate for Marital Intimacy logo

Apostolate for Marital Intimacy

Sexuality Assessment


Apostolate for Marital Intimacy

Submit Coaching Inquiry

Discovery Call

15 minutes
On Zoom

Select a Date and Time

Sun
Mon
Tue
Wed
Thu
Fri
Sat
Time Zone
UTC
Name*
Email*

Sexual History

Address Line 1*
Address Line 2
City*
State*
Postal Code*
Country*
Your Biological Sex*
Your Government-Issued Photo ID (Driver’s License, Military ID, Passport, etc.)*
We collect this for identity verification and legal compliance.
What Religion Do you Practice?*
This is for context only. Services are provided regardless of religion practiced.
Your Relationship Status*
Your Wedding Date

Your Spouse/Partner's Information

  • If you are married, dating, or engaged, your spouses/partner is required to be informed of and willing to participate in the coaching process.
  • If you are not married, dating, or engaged, please write N/A in the fields below.
Your Spouse/Partner’s Name*
Your Spouse/Partner’s Email*
Your Spouse/Partner’s Phone*
Your Spouse/Partner’s Biological Sex*
Your Spouse’s Government-Issued Photo ID (Driver’s License, Military ID, Passport, etc.)*
We collect this for identity verification and legal compliance. If you are not married, dating, or engaged, you can re-upload your own.
Your Spouse/Partner's Religion*
This is for context only. Services are provided regardless of religion practiced.

Your Children (biological, step, adopted, long-term foster)

If you do not have any children, please write N/A in the fields below.
Their Names and Ages*
Is there anything else that would be helpful for us to know about your children (medical/mental complexity, etc.)? If so, please explain.*
Will your children be involved in the coaching process?*
Are you or your spouse/partner currently pregnant?*
Due Date (or N/A)*

Financial Information

Effective coaching requires a significant investment of time and money. If you would like to be considered for a discount or sliding scale rate, please complete the fields below.
Your Estimated Annual Household Gross Income
How many people are in your household (include yourself)?
Discount Qualification (Please select all that you or your spouse qualify for.)

Coaching Program

Are there a specific coaching programs that you are interested in?*
Briefly describe why you are seeking coaching and what you would like to get out of it.*
How did you hear about us?*
By signing below, I affirm that I have read and consent to the Coaching Policies of the Apostolate for Marital Intimacy, Inc.
The current policies can be found at https://www.catholicintimacy.org/coaching-policies.
My Signature*
draw your signature

Amount to be charged:

Payment Info

C

Catholic Intimacy Booking Assistant

Get answers about booking your consultation, the inquiry process, identification uploads, and which coaching programs may relate to your situation.

C
Welcome! I’m Catholic Intimacy’s AI booking assistant. I can help with questions about scheduling your consultation, the consultation fee, identification uploads, the inquiry form, or which coaching programs may relate to your situation. Please use the booking form on this page for documents and personal details.
More below
Tap to start
Before we continue...
Please share your contact information so we can follow up with you.