Resources champion & feedback form - Polyvagal Teen® - Getting to know your nervous system!

We at Watoto Play would love to celebrate you!

We understand you are hard at work supporting change in your personal life or the lives of clients and its time we put a spotlight on the work you are doing.

Fill out this form to share your achievements since purchasing our products. No win is too big or small, we are just looking for inspiring and transformative ways to use our resources to inspire others. In return we will promote your practice by sharing your links & championing you!

We have been getting enquiries for therapists from people who have purchased our products (especially Polyvagal Teen®). We are creating a list of therapists who use our products we can refer onto. Just opt in if you would like to be included in the list.

Do you use our products for

Your Email Address

Confirm Your Email Address

Your Professional Name

First

Last

Therapy Practice Website / Facebook Page URL (Anything you want to promote)

What's Your Professional Title (job)

Upload A Suitable Pic

Maximum file size: 1MB

Which Of Our Resources Do You Have?

The Hearts Whisper® - Ukraine

The What's Your State Polyvagal Teen® - Card

Neurosloths™ - the Little Book Of Traits

Neurosloths™ Card Deck

The Empty Chair Cards

What challenges were you struggling with before you used the Hearts Whisper - Ukraine Cards?

What challenges were you struggling with before you used the What's Your State Polyvagal Teen®?

What challenges were you struggling with before you used the Empty Chair Cards?

What would you say was your biggest WIN as a result of purchasing our product?

If you purchased more than one - please create a heading for each win relating to the resource.

Are there any cards you would like to see added to a card deck? Or do you have feedback you would like to share with us?

Did you really love our products so much that would would do a 2 min video of your responses? All you need to say is what you have written in your written responses

Maximum file size: 5MB

Would You Like Your Professional Details Added To Our Referral List?

Yes

What do you offer?

Therapy

Coaching

Supervision

Training

How You Offer Therapy

In Person

Face To Face

Outdoor

Animal Assisted

Practice Name & Address Details - Only fill first part of postcode

City

State/Province

Zip/Postal only first part

Country

Your preferred profile url/ web address to be shared

Watoto Play Ltd. is collecting testimonials from users of its products, services, and consultations. We intend to use the testimonial you provide, along with the name, image, likeness, and other personal characteristics you provide below as part of our advertising, promotion, and other commercial and business purposes. By completing this form and submitting a testimonial, you are agreeing to allow Watoto Play Ltd to use your name, image, likeness, video, and other personal information you submit for that purpose. You agree that the value you gained and will gain from the use of Watoto Play products is sufficient to grant your permission for the use of your name, image, and likeness.*

I agree

If you are human, leave this field blank.

Resources Feedback & Championing You!

If you or a loved one are in crisis please seek emergency support

Our Polyvagal World

Join The Conversation: BOOK NOW
Wed. 7th of Feb 2004 7.15PM GMT
Live With Dr Stephen PORGES

Online EVENT CELEBRATING CHILDREN'S MENTAL HEALTH WEEK
SELF SELECT FEE MINIMUM £1.00

Resources Feedback & Championing You!

If you or a loved one are in crisis please seek emergency support

Our Polyvagal World

Join The Conversation: BOOK NOW Wed. 7th of Feb 2004 7.15PM GMT Live With Dr Stephen PORGES

Online EVENT CELEBRATING CHILDREN'S MENTAL HEALTH WEEK SELF SELECT FEE MINIMUM £1.00

Join The Conversation: BOOK NOW
Wed. 7th of Feb 2004 7.15PM GMT
Live With Dr Stephen PORGES

Online EVENT CELEBRATING CHILDREN'S MENTAL HEALTH WEEK
SELF SELECT FEE MINIMUM £1.00