Intake form

Name *

Email address *

What is your primary goal for seeking somatic healing?

Please select at least one option.

Increase focus

Enhance mindfulness

Manage stress

Improve emotional regulation

Develop coping strategies

How would you describe your current level of stress?

What specific challenges related to ADHD are you currently facing?

Have you previously participated in any therapeutic or holistic practices?

What types of holistic practices are you interested in?

Please select at least one option.

Meditation

Breathwork

Yoga

Mindfulness

Movement therapy

Are you currently working with any other healthcare professionals?

If yes, please specify their role or specialty.

Do you have any medical conditions or concerns we should be aware of?

How did you hear about the somatic sanctuary?

Which service or services are you interested in?

Please select at least one option.

Somatic Mind-Body healing

Personalized mindfulness techniques

Empowerment workshops

Additional questions or comments

The Somatic Sanctuary