2026 Soma Fill-In Model Registration

2026 Soma Fill-in Registration

Thanks for your interest in being a clinic model for our students. If we have a cancellation and need someone to fill-in at the last minute, a student may reach out to you directly via phone or email to schedule a one-off session. Please let us know which appointment times would work with your schedule, and we look forward to sharing this powerful work with you!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Date of Birth
Month, Day, Year
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Appointment Times

Appointments last around 2 hours and cost $60 each. Please select all appointment time slots that you would be available to attend.
Tuesdays at 12/12:15pmTuesdays at 3/3:15pmWednesdays at 12/12:15pmWednesdays at 1:00pmWednesdays at 3/3:15pmThursdays at 9/9:15amThursdays at 11:15/30amThursdays at 1:30/45pmThursdays at 3:45/4:00pm
Is there anything else we should know regarding your schedule or day/time preference?
Tuesday at 12:00pm
Tuesday at 12:15pm
Tuesday at 3:00pm
Tuesday at 3:15pm
Wednesday at 9am
Wednesday at 9:15am
Wednesday’s at 11:30am
Wednesday’s at 11:45am
If you have any questions or concerns, please email us at somainfo@soma-institute.org

Soma Institute of Structural Integration
Soma Clinic: 772 Camano Avenue, Suite 101, Langley, WA 98260
360.680.3053 | somainfo@soma-institute.org
www.soma-institute.org
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Appointment Times