First Name *

Family Name

E-Mail *

Telephone number

Street Address

City

Province or State

Postal Code

Age

Date of birth

Skype address

Zoom address

Emergency Contact Person *

Emergency Contact Person’S Phone Number

Class Interests (Please hold the shift key to select more than one modality) * MoveFocusPrepare for Earthquake PreparednessTaijiquanMovement Intelligence: Bones for Life®Movement Intelligence: ChairsMovement Intelligence: Mindful EatingMovement Intelligence: Walk for LifeMovement Intelligence: Solutions for Optimum MobilityMovement Intelligence: Teacher or Mentor Certification TrainingFeldenkrais Method® of Somatic Education: Awareness Through Movement® Lessons and ClassesFeldenkrais Method® of Somatic Education Individual Functional Integration LessonsSounder Sleep System™Inner Relationship FocusingMeditative ListeningWholebody FocusingFocusing & DreamsFocusing & PhilosophyLevel One Focusing: Encountering the Inner RelationshipLevel Two Focusing: Accompanying the Inner RelationshipLevel Three Focusing: The Centre of the MazeLevel Four Focusing: Helping with Difficulties

Previous experience with movement studies

Any injuries or special concerns?

Other practitioners you are currently seeing...

Education and background

How do you spend your days?

What is easy for you?

What is not easy just now?

Four related questions to consider:

1. What abilities would you like to develop?

2. What is your attitude about developing these abilities?

3. What do you hope may happen when you develop these?

4. What do you see as the facilitator’s role in helping you to develop these abilities?

Questions, wishes or concerns about the lessons? *

How did you hear about Thinking in Movement Studio?

Are you interested in any of the following: (please hold the shift key to select more than one option) Free ConsultationWork Study ScholarshipContinuing Education CreditsExtended Health Insurance Benefits