Body Centred Therapy Registration Form

Body Centred Therapy Registration Form
Participant Name
About Body-Centred Therapy

Body-centred therapy is a holistic and integrative approach that may include verbal exploration, breathwork, guided movement, touch-based techniques, and energy awareness practices. This work invites a deeper connection to your body, emotions, and internal experiences, with the aim of increasing awareness, integration, and self-regulation.  This practice is non-diagnostic and does not seek to pathologize. We hold the perspective that there is nothing to fix — we support the unfolding of your own inner wisdom and innate capacity for wholeness.
Informed Concent
Acknowledgment and Signature
Participant Signature:
Pre-Session Intake Form
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Email
example@example.com
Emergency Contact Name and Number:
GP Name and Contact (optional):
Health & Wellbeing Overview
1. What brings you to therapy at this time?
2. Are there particular areas of your life/body you wish to explore or support?
3. Do you have any current or past medical conditions (physical or mental) we should be aware of?
4. Are you currently taking any medications? If yes, please list:
5. Is there anything else you'd like me to know before we begin?
Touch Consent for Optional Hands-On Adjustments

Some body-centred therapy sessions may include the use of gentle, respectful physical touch to support grounding, regulation, emotional processing, or awareness. All touch will be clearly explained before being offered and will only be used with your explicit verbal consent.You have the right to say 'no' or withdraw consent at any time, without explanation. The intention is always to support your process, comfort, and autonomy.
Please indicate below:
I consent to the use of physical touch in sessions, as discussed and agreed verbally in the moment.
I prefer not to receive physical touch as part of therapy sessions.
Client Signature:
Date of Signature

MonthDayYear
Date
Post-Session Care Tips

After a body-centred therapy session, it’s normal to feel a range of emotions or physical sensations. You may feel deeply relaxed, tired, emotional, or spacious. The following practices can support your integration:
- Drink water and rest if needed.
- Avoid scheduling anything too intense or demanding immediately afterward.
- Notice and journal any emotions or insights that arise.
- Gentle movement (walking, stretching) can help release residual tension.
- Reach out if you have questions or feel unsettled in the days following your session.
Thank you for allowing me to support your journey.
Should be Empty:

Body Centred Therapy Registration Form

Informed Concent

Acknowledgment and Signature

Touch Consent for Optional Hands-On Adjustments