Safe & Sound Protocol Application
Hello! I appreciate your interest in the Safe & Sound Protocol and I'm so glad you're here!

My intention for this application is to learn a bit about you, what brings you here and for you to ask me anything you need to know in order to help you feel sure about this therapy and experience with me.

After I receive your application, I will follow up via e-mail* to schedule a complimentary 30 minute individual meet and greet with me via Zoom. During this time we will go over a bit of your history, desired goals and outcomes for your time in this experience, take time to ask and answer any questions and make sure this group and modality feel like a good fit.

Next steps after the initial meeting can include:

a) signing up to join the cohort of your choice and paying your deposit (group applicants)
b) talking about a schedule that suits you and making a plan (individual applicants)
c) joining a waitlist - if cohorts or individual spaces are full (all applicants)


Looking forward to connecting,
Errin

*I am a one person operation and do my best to get back to folks within 2-3 business days. 
If you should not hear from me within 2-3 business days, please feel free to email me at hello@errinlavaque.com and provide a friendly nudge!
Sign in to Google to save your progress. Learn more
Email *
Name *
Phone Number *
Address *
Time Zone *
What are your pronouns, if you'd like to share? 
(Mine are she/her)
Which SSP delivery method are you interested in?
 *
Required
Group Applicants:
Which cohort would you prefer? 
You may pick more than one if your availability allows options. 
 *
Required
Individual Applicants:
What is your availability for SSP sessions?
 *
Required
All Applicants:
Do you have what you need in order to participate?
Online Delivery Options: a quiet, uninterruptable space, internet connection, zoom account, smart phone to access SSP playlists, over-the-ear non-noise canceling headphones
In Person Delivery Option: KN95/N95 respiratory mask, smart phone to access SSP playlists, over-the-ear non-noise canceling headphones
 *
All Applicants:
Do you know which rate you are on the sliding scale? Please expect to have a conversation about your Rate determination with me. 
 *
Required
Group Applicants:
This is a 12 week small group container with weekly 2 hour zoom meetings. Are you able to commit to showing up each week? 
(First and Last weeks are 3 hours)
If applying for individual experience, please answer N/A
 *
Group Applicants: 
We'll have a minimum of 3 and a maximum of 6 participants in each group. Are you willing to commit to holding confidentiality about what happens in our group (not sharing others' experiences outside of our group), honor folks' identities (including but not limited to: cultural background, gender identities and pronouns) and ask permission before offering unsolicited advice? 
If applying for individual experience, please answer N/A
 *
All Applicants:
How did you hear about this offering?
 *
All Applicants:
What draws you to this experience?
 *
All Applicants:
Do you have experience with somatic work, nervous system healing or education, traditional psychotherapy or other healing modalities? 
This is not a prerequisite. I'm just curious how you might be arriving and what you've experienced
 *
All Applicants:
Are there any questions you have for me about the SSP experience, about myself and/or the way I facilitate/hold space? 
Feel free to ask them here.
 *
All Applicants:
Is there anything you feel nervous or unsure about regarding the SSP experience? Are there any ongoing struggles you're worried might make the SSP more challenging for you? Any additional support you feel like you might need and don't have? 
Feel free to share here, and we can chat more, if that feels supportive.
 *
All Applicants:
Is there a particular symptom, feeling or behavior you are hoping to alleviate by utilizing the SSP?
 *
All Applicants:
Is there a particular symptom, feeling or behavior you are hoping to increase by utilizing the SSP?
 *

Dr. Stephen Porges has described the SSP as a “potent” intervention. Many people experience stronger emotions for a short time as their defense mechanisms lower. There are some indications that the Safe & Sound Protocol is not an appropriate intervention if the following is occurring at the time of administering SSP. 

Please check if any of the following contraindications apply to you:

 *
Required
All Applicants:
Is there anything else that you'd like me to know about you, your experience, or what kind of support you like/need?
We will continue to explore this question and answer during our time together as our relationship develops and unfolds.
 *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Errin LaVaque Integrative Somatic Therapies.

Does this form look suspicious? Report

Google Forms