Intake form for 1:1 Somatic Sessions with Ev'Yan — Ev'Yan Whitney, Sexuality Doula®

Intake form for 1:1 somatic sessions with Ev’Yan

Hey! I’m really looking forward to connecting with you soon.

Before our session, please fill out the form below to give me a glimpse of who you are and what you’d like to focus on during our time together.

Your answers not only help me prepare for our upcoming session, it’s also an opportunity for you to reflect and bring attention to what you’d like to dive into during our time together.

Feel free to share as much as you feel comfortable with and please be as specific as possible. There are no wrong answers, just be as honest as you can—even if it means you’re not sure how to answer.

Please have this form filled out at least 24 hours before our session.

*Note: All information and responses are confidential will be seen by my (Ev’Yan) eyes only.

Name

First Name

Last Name

Pronouns

What relationship do you currently have with your body?

If you could have it your way, how would you want your relationship with your body to look + feel like?

List practices, habits, or other ways of being you'd like to experience. Allow yourself to dream here, even if it doesn't seem possible.

What do you think is getting in the way of you having that kind of relationship?

What is your priority focus for our session?

What's something else that you'd really like to dive into if we have time?

Have you ever been in therapy before?

Yes

Are there any physical, emotional, mental, or spiritual moments that have shaped and impacted your body? Any particular experiences that are useful for me to understand going into our session?

What support systems do you have currently in your life that'll help you integrate what we uncover during our session?

i.e., therapy, group spaces, loved ones or chosen family you can discuss/be in practice with.

Anything else you'd like me to know?

*All information and responses are confidential and will be seen by my (Ev’Yan) eyes only.