Beginning survey

Beginning Survey

Welcome and thank you for your decision to start a Somatic Coaching or a Somatic Movement Therapy!
To work successfully in supporting a helpul and healing development I need information.
Could you please help me in answering the questions in this and the following surveys?
Thank you.
Dieter Rehberg

All information that you provide in this survey is strictly confidential.

* Indicates required field

Name *

First

Last

email *

Adresse *

Line 1

Line 2

City

State

Zip Code

Country

Date of birth *

Age *

Gender *

highest education *

Profession *

Do you have children? *

yes no

How many children? *

Age of children *

Do you live in partnership? *

I like all your information! But if you do not know what to write, you can also just write: " I dont know."

What is your motivation to begin a treatment in Somatic Coaching or Somatic Movement Therapy? Describe in your personal words please: *

How is your body right now? Do you have any physical issues like pain? *

What is your mental state? Is there any suffering in your feeling or thinking? *

Do you have any diagnosed illnesses? *

You can upload any diagnoses here: *

Max. Dateigröße: 20 MB

Do you take any medicine? *

Are you currently being medically treated? *

Do you have any experience in the somatic field? *

How are you right now? Describe in in your personal words: *

Somatic Coaching and Somatic Movement Therapy in the method PME is bio-psycho-social health promotion and could change my body and mind as well as my perception and behavior. Somatic Coaching and Somatic Movement Therapy in the method PME is not a substitute for medical or psychotherapeutic treatment. Somatic Coaching and Somatic Movement Therapy in the method PME is performed according to the Code of Ethics + Standards of Practice of ISMETA (link) as well as according to the "Standes- und Ausübungsregeln für Lebens- und Sozialberatung" (link)

I agree *

yes

Thank you!

Absenden