Group Interest Form
Welcome!

Thank you for your interest in our group offerings. 

You landed here because of your interest in self work.

I am excited that you chose to take this steps to learn coping strategies, stress management and improve your overall wellness.

Let me remind you that this is a virutal group that will meet via a video conferencing platform. Unlike most in-person groups that offer support, psychoeducation and therapy, more people are finding virtual groups to be much more convenient and just as effective.

As with most groups, there is a minimum membership needed to start. Consequently, we can not begin until  initial assessments with appropriate members are complete. 

Please read and complete this form as soon as possbile to help determine proper fit for the group.


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TAP INTO WELLNESS NOW OPEN
Today's Date *
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First and Last Name *
What is Tapping?

EFT or Emotional Freedom Technique is a form of psychological acupressure, based on the same energy meridians used in traditional acupuncture to treat physical and emotional discomforts for over five thousand years, but without the invasiveness of needles.

Tapping is a practical tool, yet highly effective.

Research shows that the black community experience early health deterioration due several factors. These factors include the cumulative impact of repeated experiences with social alienation, economic and institutional exclusion, bias, and political marginalization. 

The wear and tear on the body from chronic and toxic stress on black women in particular, is disheartening.

Subsequently, I create groups to help mitigate the psychological and physiological 'weathering' effects that most black women endure including: toxic work environments, generational trauma, imposter syndrome, a problematic inner critic and so much more.

If you want to be among a community of like minded women who share a similar lived expereince, then please join me for my upcoming 5 week group.

You will learn to use my culturally attuned Tapping approach to calm, reset and rewire your brain and nervous system for optimal functioning and wellbeing.



                        ~Memorandum of Understanding ~

I understand that all members will be screened and interviewed to determine the appropriate fit, as certain groups are not for everyone.

I understand this group is designed to provide a brave space to share and learn ways to restore my own body, mind and spirit to the best of my ability. This includes sharing, listening and engaging with various holistic tools including tapping. I understand that everyone responds differently and that no outcome are guarenteed.

I understand that I hold noone liable for my health and safety including any of the members, facilitators and afflialites of Inner Coach Counseling, LLC; however the facilitator will do what is humanely possible within the confines of a virtual community to create a safe and brave space.

What to Wear:

I agree to wear clothing that does not reveal or expose my body or that which may be perceived as offensive. However, I shall wear clothing that is comfortably, stretchable or breathable.
 
What to Bring:

I agree to bring my willingness and openness to share, listen and engage in non-destructive ways. I shall also bring water, a blanket and any item that provides additional support, warmth or comfort. 

STRICT confidentiality:

Some members may uncover painful and difficult experiences, therefore I agree to refrain from judgement and unsolicited advice. I can however offer non-judgemental and compassionate words of support.

Commitment:

As a member of this group, I commit to attending all sessions with my camera on. I understand that one excused absence is allowed but discouraged unless I am sick or have another emergency. I understand that I am at risk for removal from the group if I miss more than one session or if I breach, violate, share or record the private and confidential information shared in the group. 

Make Up Sessions:

Make up sessions are not offered. No refunds will be provided for any missed sessions. 

Group Rules (Abbreviated):

We ask that all members be mindful and respectful of the group rules which may include: 

1. Showing up on time for the session. 
2. Staying the full duration of the session. 
3. Attend all sessions (for closed groups), with one excused absence. 
4. Not smoke (marijuana), use alcohol or drugs during or just prior to the session. 
6. Avoid interrupting others when they are speaking. 
7. Act respectfully toward members and the facilitator. 
8. Respect the right to privacy and confidentiality of each member and his/her personal information . 
9. Not share or disseminate (including video or audio) confidential information discussed in the group.
10.  Avoid group member interactions outside of group. 11. Avoid giving unsolicited advice to fellow members of the group. 
12. Keep camera on during the session.
13. Make payment as agreed. 

Signed Consent:

Do you agree to read and sign the consent form that will be sent to you and adhere to what was stated above?


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I understand that the total investment for all 5 sessions is $200. I understand that If approved, my spot is not secured until the initial payment of $100  is processed not less than seven (7) days prior the start of the group.  I also agree that the $100 balance will be charged on the first day of group. I agree to put my credit card on file to process payments.
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Refund Policy:  I understand that refunds will not be honored less than seven (5) business days prior to the beginning of the first session or for any missed sessions.
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