Integrative Somatic Coaching Intake Form - Dr. Rachael Muster
Hello and Welcome to the Sanctuary
Please fill out this intake form and someone will respond. 
Visit us at www.shineohio.com/the-sanctuary for more information
Email *
First and Last Name *
Email *
Phone Number *
Presenting Focus
What brings you to Integrative Somatic Coaching at this time? (Concerns, goals, symptoms, patterns, transitions, challenges)
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What would you most like to shift, understand, or resolve?
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What are the 1–3 most important outcomes you hope to achieve?
Body Awareness & Connection
How would you describe your current relationship with your body?
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What situations, if any, make you feel disconnected from your body?
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When do you feel most at ease or grounded in your body?
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Stress & Regulation
How do you typically respond to stress? (physical sensations, behaviors, etc.)
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Do you have any grounding or calming practices that work well for you?
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Learning & Comfort Preferences
How do you learn best? (visual, verbal, experiential, touch-based, movement-based)
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Are there any accommodations or sensitivities you would like me to be aware of (sensory, trauma-related, etc.)?
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Are there any areas of your body or topics you do not wish to explore during coaching sessions?
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Are you open to gentle movement, guided breathwork, or somatic practices as part of coaching?
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Required
Logistics
Preferred session format:
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Required
Preferred session length: *
Required
Boundaries & Consent
In an effort to avoid dual relationships, Dr. Rachael Muster cannot provide Integrative Somatic Coaching to current or past Clinical Counseling clients. Are you a current or past counseling client of Dr. Rachael Muster?
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Please review the Integrative Somatic Coaching Agreement before proceeding:
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