New Client Intake Form & Liability Release
First Name, Last Name *
Gender/Preferred Pronouns *
Email *
Phone Number *
First, tell Me about Yourself! What does your lifestyle look like? What do you do in your leisure time? What brings you joy and sparks your spirit? *
Are you happy at your current place of employment? If not, take a moment to tell me what you would like to be different.
Do you live a fairly active lifestyle? If so, what type of activities/exercises ignite you? How often do you participate in these activities?
What reasons or defining life events drew you to seek out embodiment coaching? *
What drew you to my style of coaching and my work? *
What are your intentions and desires for our work together? *
Please choose a number for the 2 questions below 1 (Strongly Agree) 5 (Strongly disagree)
I am able to easily accept support from others and contribute to their lives
Clear selection
When I have a setback in life, I'm resilient and bounce back quickly.
Clear selection
Please Take a moment to reflect and consider the following (1 being little to none and 5 being extreme):
Family Stress *
Relationship Stress
Clear selection
Work Stress *
Financial Stress *
Health Stress *
Do you have any type of daily meditation practice? If so, what type of meditation do you gravitate towards and how often do you practice meditation(s)?
What are some of your core values? What is most important to you in life?
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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