Individual Therapy - Welcome Survey
Thanks for your interest in our individual dance therapy!
You may have been in therapy before and understand a lot about yourself. You know your patterns, but making a real lasting change is a challenge for you. You suspect trauma and over-stress may play a role and block you from moving forward in your life. Especially if you feel words are not (or have been) enough, then this is for you!

Practical details:
- Check out our website for more info: www.expat-wellbeing.nl
- Questions? Email or call me at irene@expat-wellbeing.nl / 06 41 28 67 22

This exercise will take you about 8 minutes to complete. Your answers will help me identify issues we need to focus on to help you get the best result. Let's get started.
What is the reason / circumstance that you moved here? *
Answer if applicable.
Your answer
How good/ healthy/ fit do you feel? (on a 0-10 scale) *
0 means you feel completely miserable or are constantly sick, while 10 may mean you feel you're at your best and enjoy life to the fullest
Your answer
How aware are you of your body & sensations? (on a 0-10 scale) *
0 may mean you don't feel your body unless it's in pain, 10 may mean you often are aware of your breathing or know very well your physical capability & boundaries
Your answer
How comfortable are you with moving your body? (on a 0-10 scale) *
0 may mean you're terrified to even gesture with your body or are in pain to move freely, while 10 may mean you feel truly yourself when dancing, running, sporting, etc
Your answer
What challenges are you experiencing? *
Feel free to think broadly including all aspects of your life e.g. friendship / relationship, culture shock, stress, unhealthy habits, mental health issues, etc.
Your answer
What have you tried to address these challenges? What were the results? *
Your answer
If you had a magic wand that would instantly make you happier, in what specific areas in your life would you most want to improve? *
Your answer
What appealed to you most about Dance Therapy? And why individual, instead of group? *
Your answer
What personal goal would you like to achieve through this therapy? How would you evaluate this, say in 3 months from now? *
Your answer
Have you been in therapy before (group or individual)? *
Your answer
If you answer YES above, do you allow me to ask you some questions by phone? *
Your answer
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