SOMATIC STRATEGY
INDIVIDUAL INTAKE FORM
Please fill in this short intake form to apply for a Complimentary Consultation or
an Assessement Session.
(Please keep in mind the difference in time zones for an online sessions)
(Please describe if applicable)
Are you or may be pregnant?
What type of appointment you'd like to book?
Please note that all data provided by you is received directly by a therapist, is considered confidential,
and will not be shared with a third party.