Birthday*

Ethnicity (choose all that apply)*

Do you identify as LGBTQ or non-binary?

Please check all that apply:*

Please check all of the types of somatic therapies you have participated in that were related to addressing your concerns of the effects of complex trauma or chronic stress on your body and mind.*

When you received this therapy did you feel a sense of safety and support before the experience.*

During the therapy did you feel a sense of safety and support.*

After the experience did you feel a sense of safety and support with the therapist.*

Would you describe your overall experience with somatic therapies as:*

Before you participated in a somatic therapy were you given (if recipient), or did you give your client (practitioner), a prescreening questionnaire or intake that specifically assessed for history of complex trauma or chronic stress. *

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