CASE STUDIES

These are clips of sessions. The Sessions are not the entire session

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SOMATIC COACHING (New Client)

First name

Last name

Email

Phone

Preferred Method of Contact

Do you have any current health issues or conditions? (Yes/No) If yes please describe

Are you taking any MH medications? If yes please list

What is your current level of physical activity?

Sedentary

Moderate

Active

Please describe any previous experience with movement (e.g., yoga, dance, martial arts,etc..)

What are your specific goals for Somatic Coaching and Movement?

What is your Occupation & how many hours do you work per week?

Do you have any stressors in your life currently? Yes/No If yes, please describe

Are there specific emotions or stressors you would like to address through Somatic Coaching?

How do you currently feel in your body?

Do you have any movement limitations? If yes, please explain what they are;

What motivated you to seek out Somatic Coaching/Therapy?

Is there anything else you would like me to know about you?

Consent:

I understand that Somatic Coaching and or Therapy is not a substitute for medical treatment: I consent to participate fully in the Somatics Sessions. This session may be used for educational purposes unless discussed prior. I will not share personal conversations and/or information. Together we will discuss what can be used and not be used.

Signature

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Date

Month

Day

Year

Schedule an appointment

June 2025

Week starting Sunday, June 8

Time zone: Coordinated Universal Time (UTC)Online meeting

Monday, Jun 9

10:00 AM - 11:00 AM

11:00 AM - 12:00 PM

12:00 PM - 1:00 PM

1:00 PM - 2:00 PM

Email

www.sensuousembodyment.info

Call

TBA

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