Somatic Coaching Intake

Somatic Coaching Intake Form

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!

First Name*

Last Name*

Email*

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/movementInterested 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 embodiment sessions. Which do you prefer?*

In Person: Lotus Pond Center for Yoga & Health Studio (in Tampa, FL)Virtually through Zoom: Client should have 15x15 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-oneSmall Group

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