Trauma Center Trauma Sensitive Yoga
with Nicole Nakamura, Psy.D., RYT-500, TCTSY-F
Enrollment Inquiry Form
Welcome! Please complete this inquiry form and schedule a 15-30 minute phone call with me (no cost) prior to signing up for TCTSY offerings. This form is designed to provide me with some information and to be a first step in you choosing if TCTSY is something you think might be useful for you. All questions, aside from your name and contact information, are optional.
Name
*
First Name
Last Name
Date of birth
-
Month
-
Day
Year
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Chosen name (if different)
Pronouns (optional)
Your Phone Number
*
Please enter a valid phone number.
Do you give me permission to leave voicemail and contact you via text messaging (text messaging only for scheduling issues)?
*
Please Select
Yes, Phone call and voicemail only
Yes, Text for scheduling purposes or updates only
Yes to all - Phone call, voicemail, and text
No - I do not give permission
Your Email
example@example.com
Would you like to be added to my email list for future offerings?
Yes, please add me to your list
No thanks
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In case of an emergency, who would you like me to contact?
First Name
Last Name
Emergency contact phone number
Please enter a valid phone number.
While TCTSY does not intentionally bring up trauma content, the practice can at times bring up emotions or memories that you might want to talk through with someone. Do you have a support person, therapist, or group/community to process your experiences with if the need arises? If so, please share who that might be here.
Name or group here
Please share a little about why you're interested in Trauma Sensitive Yoga.
Have you had any experiences with yoga or other types of movement-based activities that you'd like to share with me?
Is there anything you'd like me to know about health conditions or what it is like for you to engage in physical movements?
Is there anything you'd like me to know that would help to make the space or practice more accessible for you?
Any questions you'd like to make sure we cover in our call? Or any other notes you'd like to provide for me?
Thank you for completing this form! You will be contacted within 2 business days to schedule a consultation call.
Nicole Nakamura can be reached by phone at: 808-818-8867
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