Mentoring Intake Form Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Date of Birth * MM DD YYYY Name of Craniosacral College Training & Date completed * Please tell me about your experience with Craniosacral Therapy. What brings you to this work? How often do you use it? How do you feel when you are doing the work? What do you feel most confident about in your work? What areas would you like to improve? Being as specific as possible, please list the top three things you would most like to get out of our work together. For example, you might want to work on your hand placement for a particular technique, or you might want to practice your therapeutic dialoguing skills. Please complete the following statements: I'll feel this experience is a success if: I'm most excited about: I'm most apprehensive about: Anything else you'd like to share before we begin our work together? Thank you!I look forward to seeing you soon.