Application for individual work
Full name
*
Email
*
Phone
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Where are you based, and what is your time zone?
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Sessions are mostly online, so this helps me with scheduling.
What brings you to this work at this time?
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Which way of working are you drawn to?
Threshold – a short process of 3 sessions
Container, biweekly – 4 months, 8 sessions
Container, weekly – 4 months, 16 sessions
I'm not sure yet
Which days and times are generally possible for you?
Monday afternoon
Wednesday afternoon
Thursday afternoon / early evening
Friday afternoon / early evening
Sunday afternoon
All times are Portugal time (Lisbon).
Are you currently in therapy or another form of support, or have you been in the past?
Is there anything about your physical or mental health that I should know in order to assess whether this work is appropriate and safe for you?
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Are you currently going through an acute crisis?
Yes
No
If yes, I will respond to you personally as soon as I can. This form is not monitored in real time. If you are in immediate danger or thinking of harming yourself, please contact your local emergency services or a crisis line in your country right away.
How did you find me?
Recommendation from a client or friend
Recommendation from a professional
Bodynamic / the Association for Bodynamic Psychology
Instagram
Felt podcast
A talk, workshop or event
Search engine
Other
Anything else you would like to add?
I explicitly consent to Dana Biechonski Fernandes processing the health information I provide in this form for the purpose of assessing whether working together may be appropriate.
The information you provide will be treated confidentially and used only to review your application and communicate with you regarding potential work together. Please see the Privacy Policy for information about how your data is stored, retained, protected, and how you can exercise your data-protection rights.
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