The purpose of this survey is to learn more about your needs regarding intimacy after illness, in preparation for my RCI presentation on May 9. Your comments are confidential and individual responses will not be shared with anyone.

* 1. Are you interested in the topic of intimacy after illness from a personal perspective or as a professional relationship coach?

* 2. How important is it for you to learn more about reigniting intimacy and sexuality after illness:

* 3. What three intimacy issues or questions concern you (or your clients) most?

* 4. If you or your partner has experienced a serious illness that disrupted your love life, please indicate which illnesses had an impact on you:

* 5. Do you and/or your partner find it difficult to openly discuss sexual intimacy issues? How might I help you?

* 6. Would you like to learn more about my intimacy coaching at this time? Please enter your first name and email address in the Comments area below if you want me to contact you for a thirty-minute, complimentary break-through Intimacy Discovery Session to help you achieve the level of physical, emotional and spiritual intimacy you want in your life.

* 7. If you would like to be entered in a drawing to win a free copy of my intimacy home study course, “Ten Strategies for Reigniting Sexuality and Intimacy After a Major Illness,” please enter your first name and email address below:

Thank you for responding to this questionnaire!

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