Yoga Therapy Application

Please fill out the form below so I can get an idea of what you want to work on, and I will contact you to discuss your goals and schedule sessions!

Name

First Name

Last Name

Phone

(###)

###

####

Somatic coaching addresses goals by acknowledging the mind-body connection. Are your goals purely physical/movement based, or are you interested in working more holistically?

Purely physical/movement

Interested in working holistically

Briefly, what challenges are you facing that you want to address?

Please list professional support you are currently receiving for these challenges

Do you engage in any movement or creative practices? If so, what are they, and how often do you engage in them?

Please list 1-3 goals you want to address through somatic coaching

Anything else I should know?

In person and virtual options are available for somatic coaching sessions. Which do you prefer?

In Person: Lotus Pond Center for Yoga & Health Studio (in Tampa, FL)

Virtually through Zoom: Client should have a 10x10 ft private practice space where they will not be disturbed for the duration of the virtual session.

Are you interested in small group or one-on-one sessions?

One-on-One

Small Group (2-10 people)

Please note that somatic coaching is not a replacement for other medical or professional care. It serves as a supportive, complementary treatment to other specialized care.

I understand