In Case of (emotional) Emergency: self-care form to fill out

This form was created to accompany the Self Care Kit: For Emotional First Aid with Heart Elixir, Tulsi Elixir, Yarrow Flower Essence, and Rose Relaxation Bath Fizzies.  The kit was created with the intention of preventing burn-out and helping to promote a culture of self-care and collective-care. More info here.  Feel free to print this form, fill it out, and share.

Click here for a copy that's easier to view and print.

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In Case of (emotional) Emergency

To fill out when you’re feeling grounded, supported, calm, inspired, etc.  To read when you’re not.

I feel better when I (check all that apply/fill in the blanks)
□Go outside                                   □Call a friend                                   □Take time alone
□Share meals w/ loved ones.     □Scream into a pillow/in a car    □Dance
□Draw, color, paint, get crafty  □Play with kids                                □Cry it out
□Play soccer                                  □Connect with mentors/elders    □Go for a walk
□Have an orgasm (alone            □Clean my space/change it up     □
     or with someone else)            □Go bowling                                     □    
□Laugh (watch funny film,        □Light a candle                                □      

     hang out with fun folks)        □Get acupuncture/massage          □
□Go bowling                                 □Burn incense                                  □                        

□Massage myself with oils        □Am in water (shower, bath,         □
    before going to bed                    ocean, lake, puddle)

□Listen to good music like __________________________________________

□Watch these movies _____________________________________________


These plants support me: in the form of: tea, massage oil, bath, photos, hanging out with…

□Rose              □Milky oats           □Tulsi                    □Cinnamon      
□Nettles          □Chamomile         □Licorice root      □__________    
□Calendula     □Pine trees            □Lemon Balm     □__________
□Sunflower     □Garlic                   □Corn                    □__________

My (emotional) emergency contacts are:
I can call this person/these friends, mentors, family members, neighbors, hotlines…
*
*
*
*
*

Other suggestions:
-Start with the Basics:  Breathe.  Breathe.  Drink water!  Eat good food!

-Drained from dealing with (or not dealing with) conflict?  Role-play difficult situations/
 conversations with a friend.

-Reach-out!  Let folks know you could use some support (face-to-face or via calls/email/text/Facebook, etc.  Don’t rely on telepathy with this one!)

-Is there an element out of balance?  (Are you feeling angry, fiery, frustrated?  Get in water!
 Feeling uber-emotional or really flakey?  Go outside and feel the earth under your feet.)

-Connect with what grounds you with your deep self (beyond our daily lives): nature, meditating, looking at old photos, talking with old friends who know you well, etc.

-Take times of transition/stress to re-evaluate and learn from it all (when you’re ready)

   Take as much space as you'd like for more notes, drawings, whatever you like…

By Dana L Woodruff, community herbalist and health educator,  Dandelioness Herbals
dandelionessherbals.blogspot.com  dandelionessherbals.etsy.com  @dandelionessherbals
dandelion778@yahoo.com   facebook.com/dandelionessherbals