Healing through Empowerment
Please complete the following questions in preparation for the Healing Through Empowerment series. If you have any questions that you'd like to discuss before registering, feel free to call Clara at (207) 232-0484. Thanks.
Healing Through Empowerment Series
About the Series:
Healing through Empowerment is a group series which uses mindfulness techniques, body-based exercises, discussion, role play, verbal and physical self defense techniques, and reflection as tools for healing from abuse and assault. You will learn to observe and honor your own responses and preferences as felt in the body and develop practices to identify and express what you want, need, and feel in your own life. With an emphasis on choice and control, you'll explore and gain tools for managing adrenalin, connecting with the body and feeling it’s strength and stability for safety, healing, and growth. For more information on our healing work please visit our website www.PACMaine.com.
Your Name
Your mailing address
Email address
Phone Number
What do you hope to get out of participating in Healing Through Empowerment?
What makes you interested in the series at this point in your healing process?
Have you had the opportunity to process the abuse or assault trauma you experienced with support?
If yes, please describe what type of support you have received.
Do you have ongoing therapeutic support currently?
If yes, please share your therapist's name. (Note: we will not contact them without your consent)
Do you have any concerns or reservations about participating in the series?
Can you commit to attending all 10 sessions?
Do you intend to use insurance for the series? If self, pay skip to question
If yes or maybe, please provide the following information:
Name of Insurance Company and phone number
Name and DOB of primary insurance holder
Member ID Number
Self Pay: Our general sliding fee scale is $20 to $35 per session. Let us know what you feel will work for you.
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