Light, Love, and Reiki

Somatic Coaching Intake Form

Please complete this form before your first Somatic Coaching session.

This short form helps me understand what brings you to somatic coaching and how I can best support you. Somatic coaching is collaborative, and you are always encouraged to listen to your body, communicate your preferences and boundaries, and make choices about your participation.

Name

Phone

What brings you to somatic coaching right now?

What would you most like support with during our work together?

Have you experienced somatic or body-based practices before?

No, this is new to me

A little

Yes

Other

If you’d like, tell me a little about your experience with somatic or body-based practices:

Is there anything that would help you feel more comfortable, supported, or at ease during our sessions?

Are there any practices you’d prefer not to do, or anything you’d like me to ask permission before introducing? This might include certain movements, breathing practices, closing your eyes, or other body-focused exercises.

Is there anything else you would like me to know before we begin?

Your Choice During Sessions

Somatic coaching may include invitations to notice sensations, breathing, posture, movement, emotions, imagery, or other aspects of your present-moment experience.

You are always in choice. At any time, you may:

Pause or stop a practice
Decline any invitation or exercise
Keep your eyes open
Change your position or move your body
Ask questions or request a different approach
Take a break or end a practice

You never need to push through discomfort or participate in something that does not feel right for you.

You do not need to push through discomfort or participate in anything that does not feel right for you.

Scope of Somatic Coaching

I understand that somatic coaching is a coaching and wellness service and is not psychotherapy or medical treatment. Somatic coaching is not intended to diagnose or treat mental health or medical conditions and is not a substitute for care from a licensed mental health or medical professional.

Consent

By signing below, I acknowledge that I have read and understand the information above. I understand that my participation is voluntary and that I may communicate my needs, preferences, and boundaries at any time.

I consent to participate in somatic coaching with Amy at Light, Love & Reiki.

Signature

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Date

Month

Day

Year

How did you hear about Amy / Light, Love & Reiki?