Please fill out the form and give us an idea of your health history and current goals. We will call you to go over your submission, and see if this is the program that will work for you!
Click the button below to start.
Question 1 of 19
First Name:
Question 2 of 19
Last Name:
Question 3 of 19
Full address, including city, country and codes.
Question 4 of 19
Email Address:
Question 5 of 19
Telephone Numbers:
Question 6 of 19
Age and occupation
Question 7 of 19
Emergency Contact:
Question 8 of 19
Have you explored any somatic modalities in the past such as yoga, Mitzvah, Pilates etc? If so, what is your favorite modality to practice and why is it your favorite?
Question 9 of 19
Do you have a daily/weekly practice? If so, please tell us about it.
Question 10 of 19
What are your personal goals in working with the Somatic Stretch training program?
Question 11 of 19
Are you wanting to join for personal or professional reasons?
Question 12 of 19
Are you currently a teacher? If so, for how long and how many classes a week or month do you teach?
Question 13 of 19
What are your goals as as teacher if you become certified?
Question 14 of 19
From a student’s perspective, what qualities do you think make a great somatic educator/ teacher? Tell us about your favourite teacher and why s/he impacted you
Question 15 of 19
Are you currently taking any medications? if so, please list them and the condition you are treating.
Question 16 of 19
Are you, or have you been, under medical treatment for any physical or psychological condition? If so, please provide a detailed description.
Question 17 of 19
Are you in addiction recovery, and if so, for how long?
Question 18 of 19
Do you have any physical conditions, surgeries or injuries? If so, please describe
Question 19 of 19
Kudos for taking a powerful step on your own path of personal healing!
Is there anything else you would like to tell us?