Embodied Woman - Booking Form
- Personal Development Group for Women
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Email *
Name and Surname *
Date of Birth *
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Occupation *
Address:  *
Phone number *
Confidentiality
All the information given in this form is fully confidential and would be treated with respect. It will be read only by the workshop facilitators who are abiding to UKCP code of ethics

Safety assessment
Given the therapeutic aspect of this workshop we need some personal information about each participant who will join the group. The following questionnaire is for the facilitators to assess the needs of each participant  joining the group, and also to assess if the group work is suitable for the individual (i.e. in the cases of severe PTSD and mental health issues we recommend some one-to-one therapy before joining the group). If this is the very first time that you are joining our in person workshop please do not make a payment straight away. Please fill in this questioner and send it to us first, so the facilitators could assess if this group would be suitable for you. 

Payment
To secure your booking please make a payment by bank transfer on the same day of submitting the booking form (if you are booking for the first time please wait for our reply before making the payment):

UK PAYMENTS:
The Institute of Embodied Psychotherapy
Account No: 30354597
Sort code: 23-14-70 

GREECE & EU PAYMENTS:
The Institute of Embodied Psychotherapy 
BIC      TRWIBEB1XXX
IBAN     BE38 9677 3722 0372
CANCELATION POLICY: up to 6 weeks before the workshop - your payment will be refunded minus 20% administration fee. No refund will be offered if less then 6 weeks notice.

Concessions: If you are from a low income household and require a concession rate, please get in touch before booking. 

BOOKINGS FOR WORKSHOP IN GREECE
You can book you place either by paying the whole fee upfront or by paying 25€ deposit now and the remaining amount on the day in cash
Please indicate what rate you are paying? *
• Date of the workshop you are booking: *
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• What  are you hoping to gain from this group? *
• What is your previous experience of therapeutic work (individual/group psychotherapy, process oriented groups or any other personal development workshops): *
• What is your previous experience of body oriented psychotherapy or any therapeutic dance and movement practice: * (Please note that no prior experience of any of the above is necessary for this group). *
• Given the physical aspects of this experiential group, are there any medical or mobility issues that we need to be aware of? *
• Given the emotional aspects of this therapeutic group, are there any mental health issues or emotional problems? (Including history of depression, anxiety or mood disorders, trauma or PTSD, addictions etc.)   *
• Have you ever suffered from any serious or recurrent illnesses, or had a major surgery or accident/trauma? *
• Are you taking any medication at the moment? *
• In case of emergencies – who should we contact (name, relationship and contact details) *
• How did you hear about the group? *
• Would you like to be added to our mailing list for information about similar upcoming workshops and courses (including discounts that we offer) *
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