Practitioner Name: Raneesha Manoharan
Nature of the Session
By agreeing to this form, I understand that I am booking a one-off consultation session.
This session is educational and supportive in nature, focused on understanding the nervous system, bodily responses, and gentle regulation practices.
This is not therapy, counselling, or medical treatment, and does not constitute an ongoing therapeutic relationship.
No diagnosis, treatment, or long-term care is provided within this session.
Scope & Responsibility
I understand that this session may include discussion of:
- nervous system awareness
- practices to support regulation
- insight and education
I understand that I remain responsible for my own wellbeing, choices, and how I use any information or practices shared. I will only engage in practices in a way that feels safe and appropriate for my body and current capacity.
Support & Suitability
I understand that this session is not suitable for crisis support or urgent mental health needs. If I am experiencing significant distress, I agree to seek appropriate ongoing support alongside or instead of this session.
Contraindications – I will declare any relevant conditions that I have including, in particular, any serious mental health condition, epilepsy or asthma.
Confidentiality
Everything shared within the session will be kept confidential, except where there is a legal or ethical obligation to disclose (e.g. risk of harm to self or others, safeguarding concerns).
I understand that aspects of my case may be discussed in the practitioner’s professional supervision with a qualified supervisor. This ensures the standard of quality and safety of care. This is on a firstname basis unless otherwise required. upervision to support safe and ethical practice.
Health & Communication
I agree to inform the practitioner of any relevant information to my mental, emotional, or physical health that may impact the session. I will communicate if I feel overwhelmed, uncomfortable, or need to pause at any point during the session.
Physical Practice Disclaimer
If any body-based practices or movements are suggested, I will engage only within my own physical limits and take responsibility for my body at all times.
Fees & Cancellations
Payment is required in advance to confirm the session.
Cancellation policy:
48 hours’ notice: no fee
24 hours’ notice: 50% fee
Less than 24 hours: full fee
In the event that the Practitioner needs to cancel a session due to illness, emergency, or unforeseen circumstances, the Client will be offered the option to reschedule or receive a full refund.
Aftercare
I understand that I may experience emotional or physical responses following the session. I will take responsibility for allowing time for rest, reflection, and integration afterwards.
Sharing Stories With Care (You can opt out of this)
- The practitioner may occasionally use anonymised examples from our work for educational purposes, such as talks, workshops, or writings, to help others connect with the power of somatic healing. These real-life examples gently expand healing in the world by making this work more relatable and human. My identity will always be protected, and all identifying details removed. If I prefer not to be included in this way, I can opt out at any time through the option below.
Consent
I confirm that:
- I understand the nature and scope of this consultation
- I understand this is not therapy or medical care
- I take responsibility for my participation and wellbeing
A Copy For Your Records
A copy of this will be forwarded to you for your records by your practitioner.
