New Client Intake Form & Liability Release
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First Name, Last Name *
Gender/Preferred Pronouns
Email
Phone Number
First, tell Me about Yourself! What does your lifestyle look like and what do you do in your leisure time?
What is your current occupation? How long have you been there? Are you happy with your work?
Do you have an active lifestyle? If so, what activities do you participate in?
What reasons or life events drew you to seek out somatic coaching?
What are your intentions and desires for our work together?
Please choose a number for the questions below 1 (Strongly Agree) 5 (Strongly disagree)
I easily accept support from others and contribute to their lives
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When I have a setback in life, I'm resilient and bounce back quickly.
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Family Stress *
Relationship Stress
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Work Stress *
Financial Stress *
Health Stress *
Do you have any type of daily meditation/mindfulness practice? If so, what do you practice?
Is there anything else you would like to share with me before we begin our first session?
While I have training and experience in all of the services that I provide, I am not a licensed health care professional. Therefore, Brooke German cannot be relied upon to properly treat, diagnose, or advise any of her clients or participants. The services provided through Brooke German are offered with the view that each individual is ultimately responsible for his or her decisions, actions, and behaviors. Services provided by Brooke German are not intended to be a substitute for professional mental health or medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding health conditions. In no event shall Brooke German be held liable for any direct, indirect, incidental consequential, or punitive damages resulting from engagement with any of her services herein.
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