Wise Bodies Application
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 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 Wise Bodies? 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, body size, 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 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 a 12 week offering that meets Tuesday evenings March 17th-June 9th with no group on April 7th. Are you available all of these dates? If not, please explain *
Your answer
Wise Bodies costs $80/week or $960. Enrollment is for the whole group only. You are expected to pay the entirety of the group fee regardless of how many sessions you attend. *
There are 3 reduced fee spots available. 1 $65 spot ($780) and 2 $50 spaces ($600). These spots are reserved for QTBIPOC and those who would otherwise not be able to participate. Would you like to be considered for one of these spaces? Will you be able to participate if you don't receive one of these spots? ****Update 2/19/2020 1 $50 spot is available. This spot will be reserved for QTBIPOC.
Your answer
Various payment plans are available. All participants will be charged a minimum of $80 or your weekly session fee to reserve space. Which would you prefer? *
We will gather for group practice weekly. You will receive homework and practices to be done on your own or with other participants. It is expected that you show up to group on time and ready to practice right at 6:30. *
Wise bodies is highly experiential. We will work to actively feel into our bodies every week, often contacting difficult histories. A big part or our work will be to contact resilience in order to hold these histories, AND it is important to know that this is an experiential somatic group.
Our 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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