Have an account?

Intake form for sessions of Somatic Structural Integration | Rolfing

SOMATIC STRUCTUTAL INTEGRATION ROLFING SI

feel better, move better and reconnect your body to you inner support system.

Structural Integration is a hands-on approach that helps the body to release tension and to move with greater ease and adaptability. Rather than fixing "posture", it supports your body's natural responsiveness in the field of gravity - fostering balance, fluidity and somatic awareness.

Voornaam

Achternaam

E-mailadres

Telefoonnummer

Your Story & Intentions: What brings you to Structural Integra-on? (Any physical issues, movement goals, curiosity, etc.)

Have you received bodywork or movement-based therapies before? (Massage, physiotherapy, Feldenkrais, yoga, Tai Chi, fitness, etc.)

Do you have any current or past injuries, surgeries, or medical diagnoses I should be aware of? (Please include chronic tension, pain, or condi@ons like scoliosis, hernia, etc.)

How would you describe your current relationship with your body? (e.g. Disconnected, curious, limited, strong, painful, etc.)

Are there particular areas of the body you feel need extra attention or that feel diﬃcult to access?

What would you like to experience or gain from this session or the process if you decide to continue ?

Do you have any concerns about touch, comfort, or movement I should know about? (Privacy preferences, sensitivity to pressure, trauma history, etc.)

Do you understand that sessions take place in underwear or light clothing and involve hands-on work on a massage table and some movement explora-ons oﬀ the table? Yes / No / Not Sure — I’d like to talk more about it

Do you have any logistical needs or accessibility concerns I should be aware of?

How did you hear about this work?

Structural Integration is often offered as a series of ten sessions. These are divided into three phases:

• Sessions 1–3: Focus on the body's outer layers and surface breath

• Sessions 4–7: Address deeper structures and core alignment

• Sessions 8–10: Integrate and coordinate the whole body in movement

Each of these three parts is designed to be experienced as a coherent set, with sessions ideally scheduled closer together(within 1–2 weeks) to support continuity and integration. Depending on your individual process, your practitioner may suggest more time between certain sessions to allow deeper integration or rest. This will always be discussed and adapted to your needs.

The practitioner is member of the IASI International Association of Structural Integration, ERA Rolfing Association Europe and the Rolfing Association in The Netherlands and licensed by the CAT Collective of Alternative Therapies number 168462026-03-17

What to Expect

Structural Integration sessions take place mostly on a massage table and include some

movement explorations on or beside the table. The work involves direct contact with the

fascial system of the body and is typically done with the client in underwear or sportswear

(e.g. comfortable briefs or a two-piece set that allows access to the body’s structure).

Please bring:

• A large towel

• A pillowcase or cover for the headrest

• Optional: an extra sheet layer for warmth or comfort during movement

The space is held with professional care and clear boundaries, and your comfort and consent are essential throughout.

Address and costs

Address: Ireneboulevard 56, 2611 DT DelK (5 min walk from the sta@on, easy excess with

cars, ground floor level).

Fee: € 85.00 per session (1 hour and 15 minutes) | ITCCA members will be provided a discount code.

Practitioner: Maya-Matthea van Staden

Phone ++31(0)616070602 | via Signal | structuralintegra@on.earth

Cancellation Policy

Please note that sessions can be cancelled or rescheduled up to 48 hours in advance without charge. Cancellations made less than 48 hours before the appointment will be charged in full, except in cases of emergency.

This policy helps ensure the availability of sessions for others and respects the time and preparation involved in each appointment.

Thank you for your understanding.

Handtekening

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.