Shaking Medicine Program Application
Shaking medicine program designed to support nervous system regulation, emotional resilience, better sleep and overall well-being. As a trauma-informed somatic practitioner, I will meet you where you are at, guiding you through either  a 6 week  process or a private 1:1 session/sessions to expand your capacity for emotional regulation and deeper connection to yourself. Please fill this form out honestly to help achieve optimal results. Include anything you feel would be helpful for your session.
Email *
Release of Liability and Assumption of Risk

I hereby release Lauren Albans from all claims of damages arising from any accident or injury that is caused by or arises from my participation in anything medicine program facilitated by Lauren Albans. This includes, but is not limited to, any session held in person or online, at any location where the session takes place.


I understand that somatic practices involving movement, breathwork, and other body-based approaches that may bring up physical, emotional, or psychological responses. I acknowledge that it is my responsibility to listen to my own body, participate at my own pace, and modify or stop any activity as needed for my well-being.


I confirm that I am voluntarily engaging in these sessions and assume full responsibility for any risks, injuries, or discomforts that may occur. I acknowledge that Lauren Albans is a trauma-informed facilitator, not a licensed therapist, counselor, or medical professional, and that these sessions are not a substitute for medical or psychological treatment.


By signing this release, I agree to hold Lauren Albans harmless from any liability for personal injury, loss, or damage that may occur during or after participation in a somatic one-to-one session.

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Required
Name *
Email address *
Phone number *
Emergency contact *
Date of birth *
What would you like to apply for?
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If working in any shape or form how stressed are you usually? *
Required
When away from work your stress levels feel.... *
Just in your personal life or if not currently working you feel the majority of the time.... *
Have you experienced any physical health challenges that you feel may be connected to stress? *
Do you struggle to sleep? *
Have you experienced any types of trauma throughout your life? *
Required
What helps you feel present and relaxed ? *

To support deep and lasting healing, a combination of top-down (talk therapy) and bottom-up (somatic therapy) approaches can be incredibly effective.

Are you currently working with a therapist or counselor from a top-down perspective?

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What is your hope for investing in this shaking medicine program ? *
What is your end goal?
Is there anything else you feel is important for me to know?
I understand that this is the first step in my application. My responses will be reviewed to determine whether this offering is the right fit for me and within the facilitator’s scope of practice. If it is determined that my needs may be better supported elsewhere, I acknowledge that I may be referred to another practitioner who may or may not be able to assist.
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Required
I understand that the somatic tools and techniques explored in these sessions are a discovery of what works for me, and I acknowledge may not necessarily work for others. This process is an exploration of what supports me personally and is intended for my own integration. I acknowledge that this is not a training, and that if I pass these tools onto others including clients in my professional field, without sufficient training in this area I do so at my own and others risk. 
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A copy of your responses will be emailed to .
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