Somatic Rebalancing
1-0n-1 Clinical Somatic Intake Form
Please Read Before Booking:
Below, you’ll find my booking calendar and intake form.

Step 1: Check Availability â€“ Browse the calendar to ensure there is a date and time that works for you, but dont book yet!

Step 2: Review the Booking Intake Form - It is located below the calendar. Carefully review all details before booking your appointment (you do not have to fill it out yet)

Step 3: Book your appointment -Now that you have found a time and read over the intake form, go ahead and book your app.

Step 4: Complete the Intake Form â€“ After booking, please fill out the intake form right away and submit it.

Both the booking confirmation and intake form will also be sent to your email for your convenience. Thank you! 😊





Please read before booking and fill out this form after booking your appointment.
Appointments take place in my home in Red Deer, Alberta. The exact location will be provided in your confirmation email after booking.*
I share my home with two cats and a hypoallergenic dog. While the cats do not enter my workspace, those with allergies may still be affected. My entryway is not fully accessible, as there are a few small steps leading to the door. The exercises are performed on a yoga mat. At this time, I do not have a modified option for those with mobility limitations.*
Only the first appointment is non-committal. After your first session, you will have the option to purchase a 3-session follow-up package for $225 to continue your progess. If you’re certain you’ll be purchasing the follow-up package and would like to reserve future dates in advance, you can email me after booking your first session, and I’ll temporarily hold your preferred dates.*
Payment is due at time of booking. Refunds are not available. However, if unforeseen circumstances arise, you are welcome to reschedule your appointment to a later date.*
What do you do for work?*
Do you have any current or past medical conditions, injuries, or diagnoses or major illnesses that may impact movement?*
If yes, please describe
Have you experienced any of the following? (Check all that apply)*
Please list any others that are relevent for you.
Have you had any surgeries, past injuries, or accidents (including whiplash, falls, etc.)?*
If yes, please provide details
Do you have any mobility limitations that may affect your ability to get on and off the floor?*
If yes, please explain
Do you currently practice any movement or relaxation techniques (e.g., yoga, meditation, stretching, strength training)?*
If yes, please describe
Please let me know a bit about why you are interested in a 1-on-1 session to learn clinical somatic exercises and what your goals are? *
I understand that Clinical Somatic Exercises are a self-care practice designed to improve body awareness, reduce muscle tension, and restore natural movement patterns. These sessions are not a substitute for medical care, physical therapy, or treatment of any medical condition.*
I acknowledge that Somatic Nancy is not a medical doctor, physical therapist, or healthcare provider and does not diagnose, treat, or cure medical conditions. Any guidance provided is for educational and wellness purposes only. If I have any medical concerns, I understand that I should consult with a licensed healthcare professional.*
I understand that participation in Clinical Somatic Exercises is voluntary, and I am responsible for listening to my body, practicing within my comfort level, and communicating any discomfort or concerns. I acknowledge that, as with any movement-based practice, there is an inherent risk of discomfort or injury.*
By clicking "Yes", I agree to release Somatic Nancy from any liability related to injury, discomfort, or unexpected outcomes resulting from my participation in these sessions. I take full responsibility for my own well-being and participation.*