• Soma Institute of Structural Integration 

    Please complete and submit the following form before the start of your Soma Series. If you have any questions please let us know. All forms are HIPPA compliant.

    We are looking forward to seeing you!

     

    Thanks,

    ~ Team Soma

  • APPLICATION and CONSENT

  • I hereby apply for Soma Structural Integration bodywork and somatic education in the context of the Soma student clinic. I understand the intent is to improve the structure and functioning of my body and that the work is not represented as a substitute for medical care.

    I recognize that the process of this educational experience necessitates that my body be touched, and I give permission to student practitioners and Soma faculty to touch my body. This consent form will apply to all Soma related treatment/sessions from this date forward, unless revoked in writing, for the duration of the training.

    I understand that my paperwork/file will be retained by the Soma Institute. Beyond the cost for the session ($50), there is no additional charge for the work and the Institute will not bill any insurance as the work is being done by students, being supervised by instructors.

  • Photo Release (Optional)

    Participants may be photographed or video taped during the workshop. These photos or videos may be included for Soma Institute publications or advertisements, including on our website and various social media sites. To ensure privacy, specific names of participants will not be included. No financial compensation shall be given for use of any photographs or video.

    I acknowledge that the Soma Institute may choose not to use my photo or video at this time, but may do so at its own discretion at a later date. The Soma Institute reserves the right to discontinue use of photos or video without notice.

    I consent to and authorize the use by the Soma Institute, or anyone authorized by the Soma Institite, of any and all photographs or video which have been taken of me .

  • Initial here to consent to Photo Release          

  • I have received the Notice of Privacy Policy and have been provided an opportunity to review it. The Privacy Policy can be found here.

    I have read and understood the above statements, 

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