Supporting Neurodiverse and Highly Sensitive Clients in the Therapy Room

Supporting Neurodiverse and Highly Sensitive Clients in the Therapy Room
Name*

First NameLast Name
Email*
example@example.com
We understand everyone is different, and that small adjustments in the therapy room can make you feel more comfortable, more relaxed and ultimately make the treatments you receive more effective.

Feel free to complete this questionnaire to suit you. You are welcome to skip the sections that are of no concern to you, equally you may wish to include as much detail as you like in the areas that are of more importance to you.

We will do what we reasonably can to make the treatment space as welcoming as possible for you.
Lighting & Room Temperature
I prefer

Dim LightsBright LightsColoured LightsCandle Light
I would prefer the room, if possible to be

Below 18 °C (on the cooler side)Between 19 °C to 21 °C (normal room temperature)Over 21 °C - or could I have a heated blanket (warmer than average)
Smells
Please select the options closest to your needs

Smells don't bother me at allI struggle with strong synthetic smellsI struggle to cope with air freshener or perfumeI struggle with the smells of essential oilsOther
Feel free to add any more detail about smells that you struggle with or find comforting
Sounds, Talking and Music
Prior to the treatment

I would appreciate some time to settle in and chat before the treatment startsI'm happy to get straight on with the treatment when I arrive
I prefer

No soundRelaxing musicSounds of NatureMusic of my own choice - I will bring my ownI would like to listen to my own music with my headphones
I prefer

No talking during the treatmentI'd like you to explain everything your doing during the treatmentI like to talk a lot during treatmentsI'm happy for quiet or for you to bring up anything that arises during the session
Blankets, fabrics and products
I'm sensitive to fabrics and would prefer if possible

CottonPolyesterFleeceFaux FurI'd like to bring my own blanket
Weight of blanket

A weighted/heavier blanket would help me to relaxA lightweight blanket is better for meA regular blanket will be fineI'd like to bring my own blanket
Heated blankets

I'd love a heated blanket on the couchI'd rather not have a heated blanket on the couch
I'm sensitive to products

I prefer non-synthetic fragrance (essential oils)I prefer no fragranceI prefer organic productsI prefer natural productsI'm ok with oilI'm ok with balmI'm ok with powder
Movement
During a treatment

I'm happy to lie down and stillI'd rather stand up so I can move freely if I need toI'd like to lie down, but stand up and move around when I need toI'd rather sit in a chair
Pressure and Touch
Select all that apply

I like firm pressureI like light pressureGentle touch is OKI prefer a hands off treatmentI'm happy to go with whatever you feel is right for me on the dayI'm sensitive to touch and pressure initially, so please begin carefully and gently
Entertainment, distractions and fidgets
If you want to bring a phone, tablet, toy, game or fidget along to use during your session that is absolutely fine.
To make me aware its the end of the treatment...

Please ding a bell gentlyPlease ding a bell loudlyPlease gently squeeze my armTalk to me until I wake upOther
Virtual Treatments
For some treatments virtual treatments are an option. If you would prefer a virtual treatment would you..

I would prefer a virtual treatment and....I would prefer it to be on zoomI would prefer to email before and after the treatment
Communication & Booking Appointments
How would you prefer to book your treatments?

Online Booking SystemOver the phone with youBy emailBy text or WhatsAppWhen I see you for my appointment
If you have anything to share about how you communicate please note it down here..
Anything else you would like to share with me...
Thank you so much for taking the time to complete this form, no one is perfect and sometimes circumstances are beyond our control but we will do what we can to meet your needs. We may contact you if we need more information.

If you have any suggestions for other things that could be included on this form please email hello@gentlereleasetherapy.com
This form was produced in collaboration with the following people:

Helen Robinson, Hannah Nicklin, Fiona Purnell, Louise Power Merrick
Should be Empty:

Supporting Neurodiverse and Highly Sensitive Clients in the Therapy Room

Lighting & Room Temperature

Smells

Sounds, Talking and Music

Blankets, fabrics and products

Movement

Pressure and Touch

Entertainment, distractions and fidgets

Virtual Treatments

Communication & Booking Appointments