Body Love Group
This form is meant to provide some reflection and insight into your participation in this 12 week somatic healing 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 no later than June 15th, 2018. If you have any questions please feel free to email me at brooke@haveheartwellness.com.
Email address *
Preferred Name *
Your answer
Gender Pronoun *
Your answer
Phone *
Your answer
Email *
Your answer
How'd you hear about this group? *
Your answer
How do you identify in terms of race, class, gender, sexuality, etc? What communities are you a part of? *
Your answer
What is your current class background? (poor, working, middle, upper middle, owning)? Has this changed over time? What's your current access to resources? *
Your answer
What has your relationship to your body been like? What is it now? *
Your answer
What is your eating disorder or diet history? *
Your answer
Why do you want to participate in this group? What are you expecting to learn? What do you want to be true after 12 weeks? *
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? *
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? Access needs can be around things like chronic illness, particular scents, emotional experiences etc. What might help you be all in in this group? You're 100% at choice in what you share here.
Your answer
This group runs 12 weeks, starting in fall of 2018 (dates forthcoming) Group will be held in the Capitol Hill neighborhood of Seattle from 6-8:30 PM. Group members are expected to be on time and to attend all sessions. Can you commit to this? If not, please explain. *
Your answer
What will you pay for the group? Please consider your class background, current class experience, access to resources, networks and financial support you are connected to when making your selection. A limited number of reduced fee spaces will be available. Please consider paying at the supporting level to increase availability of sliding scale spots. *
Anything else you want me to know?
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