Client Model Application for IDA-SI 2026 Student Clinic

Client Model Application for IDA-SI 2026 Student Clinic

Please read, sign, and submit below. Applicants will be notified of selection by January 24 with the first payment due January 31.
1. Acceptance of Terms

Each Client Model is required to sign this Terms of Service Agreement in order to be eligible for participation in the 10-Series structural integration treatments during the 2026 training cohort of IDA-SI program.

2. Requirements
- Read and agree to the FAQs for Client Model of Structural Integration IDA-SI Program
- Complete of the Medical Intake form.
- Payment Options:
  - Prepay for the first 3 SI treatment sessions ($150) by January 31, 2026. Two additional payments of $200 (4 SI sessions) due May 1, 2026 and $150 (3 SI sessions) due October 1, 2026.
  - Alternatively, elect to prepay for the full 10-Series up-front ($500) by January 31, 2026.
3. Contraindications

Our student clinic is a supportive learning environment where students practice the Structural Integration 10-Series under faculty supervision. To ensure your safety and to keep the learning environment appropriate for students, certain health conditions may limit your ability to participate as a series client, even though you may still be eligible for individual non-series SI sessions outside the training.

The following are NOT eligible for participation as a client model for the 10-Series in the Student Clinic:
- Major surgery within the last 6–12 weeks
- Uncontrolled hypertension or cardiovascular disease
- Active deep vein thrombosis (DVT)
- Severe edema of unknown origin
- Severe osteoporosis
- Systemic infection (flu, fever, COVID-19, etc.)
- Active tuberculosis
- Severe or acute inflammatory flares (e.g., rheumatoid arthritis)
- Recent stroke or TIA
- Acute, unexplained neurological symptoms (sudden numbness, weakness, or foot drop)
- Active Pregnancy
- Open wounds, infections, or suspicious skin lesions
- Severe eczema or psoriasis flare in the area being worked
- Active psychosis
- Significant dissociation
- Inability to remain present during a manual therapy session
- Active substance misuse or dependence
Some conditions require additional review to determine if series work is appropriate. You may still be eligible, but we’ll check in to ensure your safety and match you with an appropriate student practitioner. In these cases, we may ask follow-up questions or recommend a modified approach. Select all that apply.*

Chronic pain conditionsFibromyalgiaHypermobility (Ehlers-Danlos or related spectrum)Mild–moderate osteoporosisRecent orthopedic injury that has healed but still affects movementHernias (inguinal, abdominal, or hiatal)Joint replacementsVaricose veinsSkin or Tissue ConditionsPTSD or trauma history that may affect comfort with bodyworkDissociation that is manageable with grounding strategiesMedications that alter sensation (blood thinners, steroids, strong painkillers)None
4. Terms of Agreement

By signing this document, you are agreeing to the following (as stated in FAQs):
- I am available at the Same Day & Time assigned to you for all 10 sessions.
- I will arrive on time for all 10 sessions at Skanner Building, 415 N Killingsworth St., Portland, Oregon 97217.
- I will stay for the entire 90-minute session.
- I am an adult (18 years +) of good mental and physical health and vitality with no contraindications listed in Section 3 above.
- I agree to receive treatment wearing appropriate clothing outlined in the FAQs.
- I will contact the Client Model Coordinator as soon as any scheduling issues arise, so an alternate Client Model can be scheduled in time for class session.
- I will provide payment in advance as outlined above, in three (3) installments ($150, $200, $150) or in one (1) installment for a total of $500 for the 10 SI treatment sessions.
5. Client Model Selection

Selection of Client Models will be prioritized for those who are available for all sessions to fulfill graduation requirements for the students.

IDA-SI reserves the right to assign/reassign Client Models to student practitioners for more resonate relationships during practicum should conflict arise between student practitioner and client.

6. Treatment Schedule

Please check your schedule carefully to see whether you are available on the following dates.

Treatment Schedule:

Session 1
Wednesday, February 11 or Thursday, February 12, 2026

Session 2
Wednesday, March 11 or Thursday, March 12, 2026

Session 3
Wednesday, April 8 or Thursday, April 9, 2026

Session 4
Wednesday, June 10 or Thursday, June 11, 2026

Session 5
Wednesday, July 15 or Thursday, July 16, 2026

Session 6
Wednesday, August 12 or Thursday, August 13, 2026

Session 7
Wednesday, September 16 or Thursday, September 17, 2026

Session 8
Wednesday, November 11 or Thursday, November 12, 2026

Session 9
Wednesday, December 2 or Thursday, December 3, 2026

Session 10

Wednesday, December 9 or Thursday, December 10, 2026

Please indicate your preferences for Day & Time of SI 90-minute treatments (1 - best availability, 2 - second best, 3 - third best.*

	1	2	3
Wednesday @ 10:00 am
Wednesday @ 1:00 pm
Wednesday @ 3:00 pm
Thursday @ 10:00 am
Thursday @ 1:00 pm
Thursday @ 3:00 pm

Based on your answers, IDA-SI will assign to you one Day & Time for all 10 sessions.
Please indicate if there are any exceptions to your availability or if you have an open availability, or if there are any other considerations IDA-SI should be aware of.
Payment Options: Prepay for the first 3 SI treatment sessions ($150) by January 31, 2026. Two additional payments of $200 (4 SI sessions) due May 1, 2026 and $150 (3 SI sessions) due October 1, 2026 OR prepay for the full 10-Series up-front ($500) by January 31, 2026. I would like to:*
Name*

First NameLast Name
Pronouns
he/him, she/her, they/them
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Preferred method of contact
If you have any questions or concerns, please contact IDA-SI:

Client Model Coordinator: Helen Drapala, LMT

E-mail: admin@ida-si.org

IDA-SI Executive Director: Jay Williams, BCSI, LMT

E-mail: innerdynamicsalliance@gmail.com

My signature below indicates agreement to all items listed in this Terms of Service agreement and in the “FAQs for Client Model of Structural Integration IDA-SI Program”.
Signature*

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