Intake & Payment - Awaken Inner Sense

Pathway 1: Neuro-Somatic Trauma & C-PTSD Recovery Online
Price range: £290.00 through £3,000.00
Select options This product has multiple variants. The options may be chosen on the product page
Pathway 1: Single Specialisms
Price range: £290.00 through £3,000.00

Select options This product has multiple variants. The options may be chosen on the product page
Pathway 2: Intertwined Specialisms
Price range: £390.00 through £4,200.00
Select options This product has multiple variants. The options may be chosen on the product page
Pathway 3: Specialist Clinical Supervision
Price range: £150.00 through £480.00
Clinicial Supervision Intake Form
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Section 1:
Name
First
Last
Professional Title:
Professional Body & Registration Number: (e.g., UKCP, BACP, NCS, etc.)
Years in Practice:
Primary Modality: (e.g., Psychodynamic, Integrative, Hypno-Psychotherapy, etc
Financial NCS,
Email
Please enter your email, so I can follow up with you.
Telephone Number
Age
Location and Time Zone
Current Practice Status:
Senior/Established Practitioner
Emerging Specialist/Neurotherapist
Neuro Student / Trainee
Other
Section 2: Practice Context & Complexity
Average Weekly Caseload Volume:
Clinical Specialisms (Select all that apply):
Complex Trauma (C-PTSD)
Narcissistic Abuse & High-Conflict Dynamics
Neurodivergent (ADHD/Autism/AuDHD) Affirming Care
Somatic/Body-Based Therapy
Energy Psychotherapy / Energy Medicine
Hormonal/Menopausal Mental Health
Other
The Complexity Map:
Section 3: The Multidimensional & Neuro-Affirming Lens Identifying the "Neurospicy" and Energetic fit.
Neuro-Identity: Do you identify as a Neurodivergent (ND) or Highly Sensitive (HSP) practitioner?
Yes
No
Exploring/Unmasking
Energetic Integration: Do you currently integrate Energy Medicine (e.g., EFT, Biofield work) into your clinical practice?
Yes, it is a foundational part of my work.
I am beginning to integrate it and need clinical oversight.
No, but I am open to the "energy-informed" lens in supervision.
Somatic Tracking: On a scale of 1-10, how aware are you of your own somatic countertransference (body responses) during sessions?
Selected Value: 0
Section 4: Supervision Requirements
Desired Supervision Structure:
Complex Case Deep Dive (90 Mins): £350
Extended Clinical Review (120 Mins): £480
Student/Trainee Container (90 Mins): £150
Specialist Group Supervision (2 Hours): £160-£240
Supervision Goals:
Section 5: Safety & Professional Responsibility
Section 6: Practice Boundaries & Clinical Commitment
1. The Fixed Container Policy:
2. Financial Commitment:
3. Ending the Supervisory Relationship:
4. Communication Boundaries:
5. Professional Ethics:
Practice Boundaries & Clinical Commitment
Practice Boundaries, Financial Consent & Container Commitment. (Please check all):
Financial Commitment & Policy: I acknowledge that all fees are paid in full to secure my placement in the diary. I understand that there is a strict no-refund, no-cancellation, and no-postponement policy. Once a diary slot is secured, it cannot be moved or refunded, and I am responsible for the full fee regardless of attendance.
Ethical Framework: I confirm that I am currently a member of a professional body (e.g., UKCP, BACP, or equivalent) and that I operate in accordance with its ethical guidelines and hold my own professional indemnity insurance.
Safety & Crisis Acknowledgement: I understand that my supervisor provides clinical oversight and is not an emergency service. I take full professional responsibility for the safety of my clients and will follow my own professional body’s safeguarding protocols in the event of a crisis.
Closing Phase Agreement: I agree to provide the required notice period (4 weeks or one full session) should I wish to end the supervisory relationship, to allow for an ethical closing process.
Confidentiality & GDPR: I understand that all client material presented in supervision will be anonymized to protect client identity, and I consent to my data being stored in accordance with UK GDPR.
Acknowledgement: By proceeding with your booking and payment, you are agreeing to enter this clinical container under these terms. You are acknowledging that this structure is in place to support your deepest transformation.
Section 7: Final Submission
Date
GDPR Agreement
I consent to having this website store my submitted information so they can respond to my inquiry.
Select options This product has multiple variants. The options may be chosen on the product page

Pathway 1: Neuro-Somatic Trauma & C-PTSD Recovery Online

Pathway 1: Single Specialisms

Pathway 2: Intertwined Specialisms

Pathway 3: Specialist Clinical Supervision