Welcome to Healing

Modern wooden house with a view of a lake and mountains at sunset.

Modern wooden house with a flat roof surrounded by tall grass and shrubs, set against a mountainous landscape.

Row of modern wooden cabins on a grassy hillside under an overcast sky.

Vineyard pathway at sunset with rows of grapevines on both sides and a clear sky.

Give yourself a pat on the back for making it here. Please fill out a few questions before our first meeting so that I can get to know you more and understand more about your world.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Date of Birth

MM

DD

YYYY

Are you currently under the care of any other providers?

Please provide their name/what care you receive from them

Are you currently on any mental health medications?

What is your life like right now? Tell me about your home, relationships, routines and sense of safety at this time.

What brings you to somatic work at this time?

What is your relationship with spirituality and religion like ?

It can be powerful to infuse somatic work with your personal beliefs. ALL belief systems are so welcome.

Tell me more about your family history. List any major traumas, diagnosis, health problems and/or addiction patterns.

Do you currently struggle with addiction or have struggled in the past?

When diving into this work it is important to nourish yourself. What resources or support can you lean on to renourish yourself after sessions?

Is there anything else I should know before we begin?