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Client Intake Form

TRE® Session with Soraya Saraswati — Overcoming the Effects of Trauma.
Please complete this form before your session. All information is kept strictly confidential.

About You

Consent

I take full responsibility for myself during the TRE session and understand I can pause or stop at any time. This form is to get a picture of my overall health and is confidential. I understand I am in control of the process and take responsibility for my health during the practice.

Health Questionnaire

Please answer what applies to you. Leave blank anything that doesn't apply.

Areas of Pain or Injury

Please tap or click on the diagram to mark any areas of pain or injury. Tap again to unselect. Selected areas will be listed below the diagram and included with your form.

Front
(your right is on the left of this image)
Back
No areas selected yet — tap the diagram above if you have pain or injuries.

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