Group Intake Form - Wellness Based Stress Management Virtual Group-Covid-19 Edition
This Stress Management Group will be held on Zoom Videoconferencing so you will need the Zoom mobile app or the www.zoom.com website. .
First & Last Name
Your answer
Your Cell Phone Number
Your answer
Your Email Address
Your answer
Your age
Your answer
Your gender expression/ gender identity (gender fluid, gender non conforming, male, female, other)
Your answer
Please list your 3 most important reasons for attending the stress management group at this time
Your answer
How familiar are you with the 8 areas of wellness , also known as SPICEES-F (social, physical, intellectual, creative/ occupational, emotional, environmental, spiritual & financial)
What do you hope to learn/ gain from attending Mindful Bodies wellness based stress management group?
Your answer
Do you have any mental health diagnosis or mental health concerns?
Your answer
Please list any additional information that you want us to know about you
Your answer
Virtual Stress Management Group Agenda & Topics: The group will be held on Zoom Videoconferencing for 8 weeks for 90 mins sessions: 10 mins - House Keeping Items. 40 mins - Action Plan Review (AKA - home practice assignments). 30 mins - Topic of the Day. 10 mins - Group Wrap Up.
Virtual Stress Management Group Topics: wk 0) Optional Interest Session for potential group members . wk 1) Defining stress, stressors, prevention, reduction & coping & Intro to SPICEES-F 8 areas of wellness. wk 2) Delving deeper into Social Wellness & Stress prevention, reduction & coping . wk 3) Delving deeper into Physical Wellness & Stress prevention, reduction & coping . wk 4) Delving deeper into Intellectual Wellness & Stress prevention, reduction & coping & The ABCDE's of CBT monitoring our how we think about stress & our self talk. wk 5) Delving deeper into Creative/ Occupational Wellness & Stress prevention, reduction & coping . wk 6) Delving deeper into Emotional Wellness & Stress prevention, reduction & coping & Assessing our Frustration Tolerance . wk 7) Delving deeper into Environmental Wellness & Stress prevention, reduction & coping . wk 8) Delving deeper into Spiritual & Financial Wellness prevention, reduction & coping , Group Wrap up & Next Steps.
If there is sufficient demand & participant interest, we will offer multiple sessions of group each week but group members only need to attend 1 weekly session. When you enroll in group, you will agree to attend the same weekly session but if you need to miss your session, then you can let the group facilitator know that you will attend one of the other sessions that week - as a makeup session. The group costs $20 per session and you only pay for 1 session per week x 8 weeks. We offer sliding fee scale (pay what you can afford) so please let the group facilitator know if need to use our sliding fee scale . Payments can be made on www.mindfulbodies.net website *
Please list which weekly session (day and time) that you plan to attend group. Please note that you can let the group facilitator know if you need to attend a different session for some of the weeks - as a make up for missing your scheduled session (please visit the news & events page of our www.mindfulbodies.net website for the dates & times of the current round of groups) *
Your answer
Group Consent and Participation Agreement Statement: I agree to keep confidential the information of other group members & I acknowledge that the group facilitators will also keep confidential the information of group members, with the exception of threats of self harm or harm to others (suicide, homicide, child abuse, elder abuse, etc). I agree that my participation in group is voluntary and I can terminate my attendance at any time. Group facilitators also reserve the right to terminate the attendance of group members who may pose an emotional or physical risk to the safety of the other group members or group facilitator. I understand that I will receive access to a digital manual for the stress management group - on goggle drive. I understand that the Action Plan Assignments in the group manual are voluntary & intended to help participants prevent, reduce & cope in healthy ways with stress & stressors, I agree that I can contact Shawnta Wright, Mindful Bodies owner, at 919-812-3172 or swright@mindfulbodies.net with any questions or concerns that I have about the group. *
Here is the link to the digital manual ,on goggle drive, which will be updated weekly. Feel free to print the manual, if you prefer a hard copy version. https://docs.google.com/document/d/1lgM-IvHvD3OudSmR86AWXRPTOkF2LxMx4J8nEhrriIc/edit?usp=sharing (please copy & paste the link into your internet browser)
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