CLIENT INTAKE & INFORMED CONSENT

A FOUNDATION OF CHOICE, TRUST & CLEAR COMMUNICATION

Welcome.

This form helps me understand anything that may be relevant to our work together and supports us in creating a space that respects your body, your boundaries, and your individual needs.

Our work is collaborative and consent-based. You remain in choice throughout the entire experience.

Please share what feels relevant. You do not need to disclose anything that you do not feel comfortable sharing, although certain information may be necessary for me to determine whether a particular practice can be offered responsibly.

The information you provide is treated confidentially and handled in accordance with my Privacy Policy.

ABOUT YOU

Full Name
(required)

Date of Birth
(required)

Email
(required)

Phone Number
(required)

Emergency Contact — Name & Phone Number
(optional)

YOUR INTENTION

What brings you to this session or journey at this moment?
(required)

Is there anything you would particularly like to explore, receive, or give space to?

How are you feeling in yourself and your body right now?

YOUR BODY & WELL-BEING

Because our work may include embodied practices, movement, breath, and—where explicitly agreed upon—professional touch or bodywork, it is important that I am aware of anything that may affect your participation.

Is there anything about your current physical health or well-being that feels relevant for me to know?
(required)

Do you currently have any injuries, significant or unexplained pain, recent surgeries, pregnancy, cardiovascular conditions, respiratory conditions, epilepsy or seizure history, or other health considerations that may affect your participation?
(required)

If yes, please share only what is relevant.

Are there any practices or forms of physical activity that you have been advised by a qualified healthcare professional to avoid or modify?
(required)

Is there anything else you feel I should know to support your participation responsibly?

EMOTIONAL WELL-BEING & CURRENT SUPPORT

Embodied work can sometimes bring forward emotions, sensations, memories, or unexpected experiences.

Are you currently receiving medical, psychological, psychiatric, psychotherapeutic, or other professional support that you feel is relevant for me to know about?

If yes, please share only what feels relevant to our work.

Is there anything about your current emotional well-being that you would like me to be aware of before we begin?

You are not required to share your full medical, therapeutic, or personal history.

TOUCH, BOUNDARIES & CHOICE

Depending on the nature of our work together, a session may include professional, consent-based touch or bodywork.

Touch is never assumed.

Consent is an ongoing conversation and can be changed or withdrawn at any moment.

How do you generally experience receiving professional, consent-based touch?

Are there any areas of your body that you do not want touched?
(required)

Are there any areas that feel sensitive or where you would like me to ask again before any touch occurs?

Is there anything that helps you feel safe, respected, and able to stay connected to yourself when receiving touch or working closely with another person?

How do you usually recognize or communicate a clear YES?

How do you usually recognize or communicate a NO, uncertainty, or a need to pause?

Is there anything else you would like me to know about your boundaries?

YOUR CONSENT & CHOICE

Please read each statement carefully and confirm your understanding.

☐ I understand that Astrid Hübner / ÁSTRIÐÚR is an embodiment facilitator and is not acting as my psychotherapist, psychologist, psychiatrist, or medical practitioner.

☐ I understand that this work is experiential, educational, somatic, and complementary in nature and is not a substitute for medical treatment, psychotherapy, psychological or psychiatric care.

☐ I understand that, depending on the session and what we mutually agree upon, the work may include embodied exploration, conversation, breath, movement, sound, meditation, energy-based practices and professional bodywork or touch.

☐ I understand that there is no fixed protocol and that each session may unfold differently according to the nature of the offering, what is present, and what I consent to.

☐ I understand that participation in any practice is voluntary. I may decline, modify, pause, or stop any practice at any time without needing to justify my decision.

☐ I understand that consent is ongoing. Consent to one practice or form of touch does not mean consent to another. I may change my mind or withdraw my consent at any time.

☐ I understand that all practitioner-client touch is professional and non-sexual in nature. There is no sexual interaction or sexual service between practitioner and client.

☐ I understand that embodied practices may sometimes bring forward unexpected physical sensations, emotions, memories, or other subjective experiences. I understand that no particular release, healing, or transformational outcome is guaranteed.

☐ I agree to communicate relevant information about my physical health, limitations, boundaries, or changes in my condition where this may reasonably affect my participation.

☐ I understand that Astrid may adapt, pause, decline, or discontinue a practice or session if she believes that continuing would be inappropriate, outside her professional scope, or not responsibly supported within the available setting.

CONSENT TO PROCESS SENSITIVE PERSONAL INFORMATION

The information you voluntarily provide in this form may include health-related or other sensitive personal information.

This information is collected only where relevant to preparing for and facilitating our work together, assessing suitability, respecting your boundaries, and supporting responsible participation.

It will be handled in accordance with the Privacy Policy.

☐ I explicitly consent to Astrid Hübner / ÁSTRIÐÚR processing the health-related and other sensitive personal information that I voluntarily provide for these purposes. I understand that I may withdraw this consent for future processing by contacting astridhuebnercom@gmail.com, subject to information that may lawfully need to be retained.

PRIVACY

☐ I confirm that I have read and understood the Privacy Policy and understand how the personal information I provide will be handled.

CODE OF ETHICS

☐ I confirm that I have read and understood the Sovereign Code of Ethics, including the principles relating to consent, professional boundaries, scope of practice, confidentiality, and the professional and non-sexual nature of the practitioner-client relationship.

TERMS & CONDITIONS

☐ I confirm that I have read and agree to the applicable Terms & Conditions, including the booking, payment, cancellation, and refund conditions.

FINAL AGREEMENT

By submitting this form, I confirm that the information I have provided is accurate to the best of my knowledge.

I understand that this work is collaborative and that I remain responsible for communicating my needs, boundaries, and choices throughout our work together.

I understand that I can ask questions at any time and that completing this form does not remove my right to change my mind or withdraw consent from any practice or touch during a session.

Full Name
(required)

Date
(required)

Signature / Electronic Confirmation
(required)

THANK YOU

Thank you for taking the time to complete this form.

Your responses help me meet you with greater awareness and care. We will continue to communicate about intentions, boundaries, and consent as our work unfolds.

You do not need to arrive in any particular way.

Come as you are.