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Somatic-Emotional Therapy – Application Form

This form helps me understand whether somatic-emotional therapy is the right support for you at this moment.


Your answers are strickly confidential.

(You might name themes, life situations, inner states, or patterns you’re noticing.)

(For example: how you feel in your body, your energy, relationships, work, sleep, or sense of presen

Which of the following themes resonate with what you are currently navigating?

(If yes, what kind of work was it, and what felt supportive or less supportive for you?)

(For example: easily overwhelmed, mostly avoiding, fairly resourced, curious but unsure.)

(Yes / No — If yes, you may add a short clarification.)

(For example: regulation, trust, aliveness, clarity, emotional safety, embodiment.)

Somatic-emotional therapy unfolds over a longer time and follows the pace of your nervous system. How does that land for you?
It feels supportive
I’m open but unsure
I’m not sure this is what I’m looking for
Other
Preferred language for sessions:
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