~New Client Intake~

Here you will find documents to read and fill out prior to your first session with me.

Before filling out and signing the Intake Form, please read the Informed Consent Statement (which outlines the nature of my practice and limitations of liability, as well as business policies), Logistics Information, and COVID-19 Policy (in-person sessions only).

By submitting the Intake Form, you agree to the contents of the following documents:

  • Informed Consent Statement;

  • Logistics Information;

  • COVID-19 Policy (in-person sessions only).

The above documents act as a contract between all clients and myself for our session work.

Logistics Information

Payment: Session fees are due at the time of service (unless we make other arrangements). I prefer payment via Venmo (@qcosmos) but also accept cash (in-person only).

Online sessions: Held via zoom. I’ll send you a link prior to our session. Please ensure you have a space free of distractions as much as possible, a suitable internet connection, and a device with a working camera and microphone.

In-person sessions: are located at 106 Dewey Ave. Eureka, MT 59917

–>Entry Door: the entry door is on the Southside of the building across the little alley from Second Chance Bakery.

–>Upon Arrival: if you arrive early please don’t knock on the door prior to your appointment time. I may be with another client. You’re welcome to knock on the door once your appointment time arrives. Upon entering, please wash your hands in the office bathroom before we start the session.


These forms are fillable and/or readable online.


These forms can be downloaded to your device and filled using the program of your choice. Once complete, please send them to CarlyRaine@calmpondpolarity.com

Have questions?

I’m happy to help, just send an email to:

Carly Rainé promotes authentic presence and integrative wellness through polarity therapy and expressive arts workshops and classes in Eureka, Montana and online.

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