*Fall Special Offer* Embodied Wellness Coaching Application Form

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Thank you for stopping by! Are you an educator, organizer or mental health professional?

Are you interested in getting evidence-based support to nurture your nervous system, improve self-care and enhance your overall well-being this fall season?

This offer might be for you <3

Tell me about yourself to see if you are a good fit for this special offer of embodied wellness coaching at a greatly reduced cost. All information gathered will be held in strict confidence.

XOXO,

Candice, Embodied Wellness + Trauma Informed Coach & Facilitator

www.candicerosevalenzuela.com

IG@education_healing_justice

** Please note that embodied wellness coaching is NOT a therapeutic service and is not intended, nor legally licensed to treat any clinical mental health concerns. ** All services are virtual, consent-based and at one's personal risk**

Email *

1. Please state your full name and pronouns. *

2. What kind of work do you do in the world? *

Teacher, educator or paraeducator

Mental health professional (social worker, counselor, therapist, etc)

Organizer

Other:

Required

3. What is your intention for seeking out embodied wellness coaching support with me? *

4. What coaching modalities are you interested in? *

1:1 Instruction for how to implement self-care in a trauma informed nervous system friendly way

Problem solving self-care challenges with options for new habits, routines and frameworks

Supportive listening and empathic reflection for self-growth & healing

1:1 Guidance & modelling of embodied wellness practices such as grounding, breathing exercises, somatic movements, etc

Guided relaxation practices & self-care time during sessions

Other:

Required

5. What are some barriers that you experience when trying to practice embodiment or self-care in your life? How do you hope that coaching will help you overcome these? *

6. Reminder! While coaching can be very beneficial, it is no substitute for clinical treatment. Coaches are neither trained nor equipped to handle mental health emergencies, nor treat active mental health conditions. Before we work together, you will receive more information and sign a contract that goes over the purpose and limits of wellness coaching. Please indicate that you understand below. *

I understand that coaching will not provide diagnosis nor treatment of mental health conditions.

If I have an active mental health concern, I may be asked to pursue therapy rather than coaching.

Required

7. Fees. These services are offered at greatly reduced cost. As such, the full payment of $200 is required in advance to secure the three-session coaching package. *

I understand and agree to pay the $200 coaching fee at least 24 hours in advance of our first session.

Other:

8. Do you have any other comments, questions or concerns? *

Thank you!

Send me a copy of my responses.

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