Name
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First Name
Last Name
Date of Birth
Email
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Phone
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What brings you to somatic coaching at this time?
Have you had experience with body-based practices before (e.g., yoga, meditation, breathwork, somatic therapy)? If so, please describe.
Are there particular areas of stress, tension, or emotion in your body that you are aware of?
What do you hope to gain from our work together?
Do you have any current or past physical injuries, chronic pain, or medical conditions that I should be aware of?
Do you experience anxiety, depression, PTSD, or any other mental health challenges? If so, how do they affect you?
Are you currently receiving support from other practitioners (e.g., therapy, chiropractic, acupuncture, bodywork)?
How do you typically respond to stress? (e.g., physically, emotionally, behaviorally)
How would you describe your relationship with your body?
Are there any emotions, memories, or themes that tend to surface when you slow down and tune in?
Do you have any spiritual or mindfulness practices that support your inner exploration?
Do you have any preferences or concerns regarding our sessions? (e.g., touch, pacing, specific approaches)
Is there anything else you would like me to know before we begin?
Consent & Agreement By signing below, you acknowledge that somatic coaching is not a substitute for medical or psychological care. You understand that this process involves deep inner work, and you agree to take responsibility for your own well-being.
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