Creative Recovery Program Application — Janesse Russel
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About
Janesse Russel
Work With Me
Services for Adults
Creative Recovery Program
Services for Teens
Speaking Engagements
Blog
Contact
Sign In
About
Janesse Russel
Work With Me
Services for Adults
Creative Recovery Program
Services for Teens
Speaking Engagements
Blog
Contact
Creative Recovery Program Application
Please complete the form below.
Next Round Begins May, 2023.
Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Shipping Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Where did you learn about me?
*
What type of art forms interest you?
*
During Coaching sessions, I love to introduce art therapy that best suits my client's interests. Let me know if you would like to try any of these mediums, check all that apply.
Therapeutic Jewelry Design
Acrylic Painting
Watercolor
Drawing/Coloring
Charcoal
Polymer Clay Sculpture
Dance
Mindful Movement
Music
Makeup
Sewing
What do you currently do to cope with stress or challenging situations?
*
What would you like to get out of our time together?
*
Have you ever had counseling, coaching, therapy or treatment before?
*
Yes
No
If you have, when? If you haven't, type N/A.
What are the best days & times to reach you?
Thank you!
