Somatic Experience Informed Consent Agreement Somatic Experience Informed Consent Agreement Consent for the Use of Touch in TherapyClient full name(Required)Date(Required) MM slash DD slash YYYY Somatic Experiencing - Consent for the Use of Touch in Therapy As part of my training and practice in Somatic Experiencing®, there may be occasions where intentional, therapeutic touch is offered as a supportive intervention. The purpose of this type of touch is to assist with regulation of the nervous system, grounding, and supporting a sense of safety and containment. Touch, when used, is always non-sexual, non-invasive, and clinically appropriate. Touch is never required and is only used with your explicit consent. If touch is being considered, we will first discuss the intention, the specific type of contact, and any concerns you may have. You have the right to decline or withdraw consent at any time, including during a session, without needing to explain or justify your decision. Declining touch will not negatively affect your therapy in any way. Consent for touch is understood as an ongoing process, not a one-time agreement. I will regularly check in with you about your experience, and we will adjust or stop any intervention if it does not feel supportive. You are encouraged to communicate any discomfort, uncertainty, or change in preference as it arises. If at any time touch feels activating, confusing, or uncomfortable, we will pause and return to verbal processing and other non-touch-based approaches.Consent decision(Required) I consent to the optional use of therapeutic touch when clinically appropriate and with check-ins I do not consent to the use of therapeutic touch Any notes, boundaries, or preferences you would like to add (optional)SignatureClient signature(Required)Therapist signature (optional) Contact Us Name Email Address What do you need support with? Your age Your ageAdolescent - 12- 18Student - 18+Adult - 23 - 31Adult - 31 - 61Adult - 61+ Tell us which days and times would suit you? 1 + 13 = Send Phone 078 869 3602 E-mail [email protected] Address Unit 2 Tonquani House 6 Gardner Williams Avenue Paardevlei, Firgrove Rural, 711019 Mark St, Stellenbosch Central, Stellenbosch, 7600 Instagram Follow Ustherapywithelonie HPCSA registration number: 0137782 Practice Number: 072 7725 Resources Solution Focused Therapy (SFT) | Ego-state Therapy | Resource Therapy | Eye Movement Integration Therapy | Brain Working Recursive Therapy | The Gottman Method