Bodies That Matter Application
This form is meant to provide some reflection and insight into your participation in this online group focusing on your connection to food and body. Thanks for taking the time to thoughtfully answer all questions. Participants will be notified of their acceptance into the group within a week of application. If group is full, you will be notified and placed on a waitlist. If you have any questions please feel free to email me at brooke@haveheartwellness.com.
Email address *
Name *
Your answer
What are your pronouns? *
Your answer
Phone *
Your answer
What has you interested in Bodies That Matter? What draws you to participate in this group? What are you hoping to transform through your participation? *
Your answer
How do you identify in terms of race, class, gender, sexuality, etc? What communities are you a part of? *
Your answer
What has your relationship to your body been like? What is it now? What is your eating disorder and diet history? *
Your answer
What feels important to name about your experience of gender or of queerness? What do you know about your relationship to body and gender? *
Your answer
What has your healing work looked like up to this point? How much intentional healing have you done? *
Your answer
What is your support system like? How supported do you feel? This may include people, pets, spiritual, religious or embodied practices, meds/supplements, etc. *
Your answer
How are you in groups? What kind of positive feedback do you get from others in groups? What about negative? How do you take feedback when you receive it? What edges do you anticipate bumping up against in this group? *
Your answer
Do you have any access needs that I should know about? What helps you feel as safe and present as possible, especially in an online/video context? You're 100% at choice in what you share here. *
Your answer
This group is an ongoing offering with zoom video meetings on Thursdays from 6:30-8:30 PM PST most weeks. Are you generally available during that time? (recordings will be available, but live attendance more often than not is expected.) * *
Bodies That Matter costs $225/month. Payment is membership based. As long as you are enrolled, you will be charged monthly on the day of your enrollment regardless of how many group practices are scheduled or how many you are able to attend live. We ask for a minimum 3 month commitment because meaningful healing takes time and commitment. Please let Brooke know two weeks in advance if you want to end after the 3 months. (Please check all boxes below) *
Required
We will gather for group practice weekly. Periodically we will take rest weeks where you will receive homework and practices to be done on your own or with other participants. We may take 1-2 "rest months" (fewer than 3 group practices in the month) per year. *
We meet by Zoom. Please download the app to your phone or computer prior to your first group date. You should be in a private and quiet place during our group to protect your own and other participants' confidentiality. Sometimes technology can be fraught! Please understand that group happens regardless of what is happening technologically. *
Bodies That Matter is an experiment in generating more embodied possibility for queer and trans communities. In the spirit of experimentation, our group may change shape and structure. Whatever change may happen will be in the principle of better alignment with my vision, your needs and feedback, and all of our desires. *
Queer and trans communities are often very small. Do you have any current conflicts I should know about? Are there any people you do not share space with? Please keep disclosures to "headline-level" summaries. I don't need every detail. We can arrange to talk more as needed. *
Your answer
Brooke Stepp is a certified nutritionist and licensed mental health counselor in Washington. As facilitator of this group, Brooke is not entering into a therapeutic relationship with you. They are serving as a guide, a facilitator, and at times a coach in your own healing. *
Anything else you want me to know?
Your answer
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