Emotional Embodiment
Program Application

Your words will be received with care. You’ll hear from me soon.

Name

First Name

Last Name

Phone

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How did you hear about this program?

What draws you to the Emotional Embodiment Program at this time?

What feels alive for you right now that makes this the right moment for deeper support?

What areas of your life or inner world do you most want to shift, heal, or open through this work?

What feels alive for you right now that makes this the right moment for deeper support?

What is your experience with the somatic, emotional, or healing space?

Tell me a little about your background with somatic or healing work — whether it’s something you’ve been practicing for years or are just beginning to explore. You might share any modalities, trainings, or personal experiences that have supported your growth so far.

What areas of your life or inner world do you most want to shift, heal, or open through this work?

You can share anything that feels true to you. Ex: emotional patterns, body experiences, or life themes you’re ready to explore.

Is there anything else you’d like to share?

You’re welcome to include anything that feels important or wants to be seen.

Emotional Embodiment Program Application

Thank you for your submission. I will be in touch soon.

Emotional Embodiment
Program Application

Thank you for your submission.
I will be in touch soon.