• Informed Consent for Therapeutic Workshops and Groups

    Please review each section and provide your information and acknowledgments to participate in Wildflower Therapies' groups.
  • Welcome

  • Thank you for your interest in Still Whole: Honoring Body Change After Surgery.

    Still Whole is a one-time therapeutic expressive arts workshop designed for individuals navigating the emotional, physical, and relational impact of body changes after surgery. Through creative expression, gentle reflection, psychoeducation, and connection with others who share similar experiences, participants are invited to explore healing in a compassionate and supportive environment.

    This workshop is facilitated by licensed mental health professionals and incorporates therapeutic principles and expressive arts interventions. While therapeutic in nature, participation in this workshop does not establish an ongoing psychotherapy relationship with Wildflower Expressive Arts Therapies.

    Please complete the following registration form. All information you provide will be kept confidential in accordance with applicable laws and professional ethical standards.

  • Participant Information

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Emergency Contact

  • Format: (000) 000-0000.
  • About You

  • Approximate Surgery Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Accessibility & Accommodations

  • Informed Consent for Participation

  • Thank you for choosing to participate in Still Whole: Honoring Body Change After Surgery.

    The purpose of this informed consent is to help you understand the nature of this workshop so that you can make an informed decision about participating.

    Nature of the Workshop


    Still Whole is a one-time therapeutic expressive arts workshop designed for individuals navigating the emotional, physical, and relational impact of body changes following surgery.

    This workshop incorporates expressive arts, guided reflection, psychoeducation, mindfulness, and facilitated group discussion. Activities are intended to support self-awareness, self-compassion, connection, and personal healing.

    The workshop is facilitated by licensed mental health professionals. Participation in this workshop does not establish an ongoing psychotherapy relationship with Wildflower Expressive Arts Therapies or its facilitators beyond the scope of this event.

     

    Potential Benefits


    While individual experiences vary, participants may experience benefits such as:

    • Increased self-compassion
    • Greater connection with others who share similar experiences
    • Opportunities for emotional expression
    • New perspectives on healing and body image
    • Increased resilience and self-awareness

    Because every person's experience is unique, no specific outcomes can be guaranteed.

     

    Potential Risks


    Participation may involve discussing personal experiences related to surgery, identity, grief, loss, body image, or healing.

    Some participants may experience temporary emotional discomfort, sadness, vulnerability, or fatigue. These responses are a normal part of engaging in therapeutic reflection.

    You are encouraged to participate at your own pace. You may decline any activity, choose not to share personal information, or step away at any time without judgment.

     

    Voluntary Participation


    Your participation is completely voluntary.

    You may:

    • Choose your level of participation.
    • Pass on any activity.
    • Take breaks as needed.
    • Leave the workshop if necessary.
    • Choosing not to participate in a particular activity will not affect your ability to remain part of the workshop.

     

    Confidentiality


    Facilitators will maintain the confidentiality of information shared during the workshop in accordance with applicable laws and professional ethical standards.

    Because this is a group experience, confidentiality among participants cannot be guaranteed. Participants are expected to respect one another's privacy and refrain from sharing another person's story or identifying information outside of the workshop.

    Facilitators may be legally required to disclose information in certain situations, including when required by law, such as concerns involving imminent risk of serious harm or suspected abuse or neglect.

     

    Crisis and Emergency Care


    Still Whole is not intended to provide crisis intervention or emergency mental health services.

    If you are currently experiencing a mental health crisis or believe you may be unable to safely participate in a therapeutic group setting, we encourage you to contact us before registering so we can discuss whether this workshop is an appropriate fit.

     

    Physical Participation


    This workshop may involve seated creative activities, gentle movement, and periods of reflection.

    Please participate within your own physical abilities and honor any limitations related to your recovery. If you have questions about whether participation is appropriate following surgery, please consult your healthcare provider.

     

    Questions


    You are encouraged to ask questions before or during the workshop. Our goal is for you to feel informed, supported, and empowered to make the choice that feels right for you.

     

    Participant Acknowledgment

    Please read the following statements and check the box below to demonstrate your understanding and agreement:

    • I have read and understand this Informed Consent.
    • I understand the therapeutic nature and purpose of this workshop.
    • I understand the potential benefits and risks of participation.
    • I understand participation is voluntary and I may decline any activity or take a break at any time.
    • I understand the confidentiality expectations and their limitations within a group setting.
    • I voluntarily choose to participate in Still Whole.
  • Emotional Readiness

    • I understand this workshop may explore emotions related to body image, grief, healing, identity, loss, self-compassion, and life after surgery.
    • I understand that participation may bring up difficult emotions or memories.
    • I understand I may choose not to participate in any activity.
    • I understand I may take a break or step away at any time.
    • I agree to care for my own emotional and physical well-being throughout the workshop.
  • Mental Health Screening

  • Are you currently working with a therapist?
  • Crisis Screening

    • I understand this workshop is not intended to provide crisis intervention or emergency mental health services.
    • I am currently emotionally stable enough to participate in a therapeutic group setting.
  • Community Agreements

  • To help create a safe and supportive experience for everyone, participants are asked to agree to the following:

     

    • I will treat fellow participants, facilitators, and the space with kindness and respect.
    • I understand that sharing personal experiences is always voluntary.
    • I agree to respect the privacy and confidentiality of other participants and will not share their stories outside of the workshop.
    • I understand that while facilitators are bound by professional confidentiality, confidentiality among participants cannot be guaranteed.
  • Workshop Acknowledgement

    •  I understand that Still Whole is a therapeutic expressive arts workshop facilitated by licensed mental health professionals.
    • I understand this workshop is not intended to provide emergency mental health services or crisis intervention.
    • I understand participation is voluntary.
    • I understand that no specific therapeutic outcome can be guaranteed.
    • I have read and agree to the Informed Consent for Therapeutic Workshop Participation.
    • I understand and agree to the cancellation policy.
  • Photography Consent (optional): From time to time, Wildflower may take photographs of the space or portions of the workshop for future educational or promotional purposes.
  • Permission for Use of Anonymous Artwork (optional)
  • By signing below, I acknowledge that the information I have provided is accurate to the best of my knowledge and that I have read and agree to the accompanying Informed Consent for Therapeutic Workshop Participation.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • My Products

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    Still Whole Registration. Fee for participation in Still Whole: Honoring Body Change After Surgery.
    Still Whole Registration

    Fee for participation in Still Whole: Honoring Body Change After Surgery.

    $85.00$85.00
      
    Total
    $0.00$0.00
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