Kiri Spiotta- Yoga and Somatics
pre consult form
Name
First Name
Last Name
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Email
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Phone Number
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Age
Occupation
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Tell me a little bit about yourself- what draws you to somatic coaching?
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Do you have an embodiment practice of sorts- including but not limited to yoga, dance, movement based practices, etc.
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Do you have a history of struggling with mental health? Where are you at present in your mental health journey?
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Are you currently seeing a therapist?
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Are you currently in crisis/experiencing a significant life event such as a death, birth, illness, etc?
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What are your biggest stressors at present?
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What are you hoping to get out of somatic coaching?
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Waiver
I understand that somatic coaching will never seek to diagnose or treat mental health conditions. Coaching is not to be used as a substitute for counselling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals and that it is my exclusive responsibility to seek such independent professional guidance as needed.
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