Guided Co-Meditation: iRest DYAD + Parts Work

1. About You

What brings you to this session?

Have you practiced yoga, meditation, or relaxation techniques before?

What are your goals for this session (calm, sleep support, stress relief, grounding, etc.)?

2. Your Experience with Anxiety

How does anxiety show up for you (racing thoughts, restlessness, muscle tension, difficulty sleeping, panic, other)?

Are there specific situations or times of day when anxiety feels strongest?

Have you noticed anything that helps calm your anxiety in the past?

3. Health & Safety

Do you have any injuries, medical conditions, or mobility limitations I should know about?

Have you ever been advised by a doctor to avoid certain positions, breathwork, or relaxation techniques?

Are you currently pregnant or postpartum?

Are you sensitive to things like touch, sound, or guided imagery that I should be aware of?

4. Comfort & Preferences

Do you prefer complete silence, gentle music, or guided voice support during relaxation?

Do you have access to props (yoga mat, blanket, pillow, bolster) if online?

Is there anything I should avoid in order to create a safe and comfortable space for you?

5. Practical Details

Do you prefer an in-person session (at my home space) or online?

What length of session feels best for you (60 minutes, 75 minutes, 90 minutes)?

Would you like suggestions for at-home practices between sessions?

Pre-Session Questions
1. Basic Information

Name:

Email / Phone:

Preferred pronouns:

2. Goals & Focus

What brings you to this session?

Are there specific challenges, emotions, or situations you’d like to explore?

What would you most like to feel by the end of the session?

3. Background & Safety

Have you experienced guided meditation, iRest, or Parts Work before?

Are there any topics, memories, or experiences you’d prefer to avoid in this session?

Do you have any mental health diagnoses or ongoing therapy you’d like me to be aware of? (optional)

Do you have any sensory or accessibility needs? (e.g., sensitivity to sound, difficulty lying down, need for breaks)

4. Comfort & Environment

Will you be in a quiet, private space where you can relax for the full session?

Do you have any props you like to use for comfort (blanket, pillow, eye mask)?

5. Consent

I understand this is not a substitute for medical or psychiatric care and is intended for personal growth and self-exploration.

Yes / No