Somatics Intake Form

Somatics Intake Form

Please fill this out in detail to identify if our Summer's 1:1 "Embodied Strength & Flow" Coaching program may be a good fit for yourjourney. Summer will review all questions.
Name

First NameLast Name
Email
example@example.com
Best Phone Number for You
Please enter your best number for your Complimentary Somatics Intake call.
What types of symptoms or conditions are you looking to get support for? Please check all that apply

BurnoutAdrenal FatigueAutoimmune DisorderElevated CortisolChronic FatigueMental Health IssuesOtherInjuriesLack of ConsistencyMental health & MindsetOptimizing performance
How long have you been struggling with these symptoms above?
To Confirm You are filling this out because you want to learn more about how "Embodied Strength & Flow" Coaching can help you Recalibrate Your nervous system, so you can increase energy, feel connected and improve your symptoms?

YES - I want to learn exactly how to recalibrate my nervous system with Somatics & FlowNo - I am going to leave this page immediately.
Which below describes your goal the most with Overcoming Burnout type symptoms and Recalibrating your nervous system?

I want to balance my mind & body and am willing to make time for self careI want mental health support so I can think clearlyI want to learn to self regulate betterI want to create a full lifestyle shift with movement, mindset & nutrition as a focus
What makes you interested in training "Embodied Strength & Flow" and recalibrating your nervous system so you can work smarter and not harder? Why is this compelling to you compared to other options for this type of support?

Add to my Skill Set & Toolbox - Because I want to actually change my habits, not just keep repeating my old patternsStart and complete a powerful strength & mobility practice at home that makes me feel empowered in my body.Learn the true connection to Body & Mind through SomaticsLearn more about how training Flow postively impacts the nervous system for the long term.
If you had a customized plan for Movement & Mindset, how many days a week would you make time to train & do breathwork exercises? (a training session is usually about an hour to be most effective)

1-2 Hours a Week to start2-3 Hours a Week3-5 Hours a WeekI'd love to do something every day of the week (highly motivated)
If you had a customized "Embodied Strength & Flow" coaching program to follow, what kind of results are you seeking in the next 90 days? (Check all that apply)

More energyMore consistency with yoga or exerciseFeeling more empoweredBetter Self Talk & Mental StateLess PainLess OverwhelmFeeling a sense of control of my outcomes in lifeA routine of wellness that I can stay consistent withOther
Be 100% honest - what do you think is stopping you from overcoming this on your own or with the resources you've tried (the more specific you are here, the faster we’ll get you clarity during our call together)*
Have you booked your 30 Minute Somatics Intake with Summer to create a clear road map to reach your goals?

YES - I can't wait to see the path.No - But I will now (https://calendly.com/summerhuntington/somaticsintake)No - I am not ready to talk to a skilled professional about change.
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