{"id":306,"date":"2026-05-11T14:16:30","date_gmt":"2026-05-11T14:16:30","guid":{"rendered":"https:\/\/sacredstudios.co.za\/?page_id=306"},"modified":"2026-07-23T12:29:29","modified_gmt":"2026-07-23T12:29:29","slug":"intake-consent-form","status":"publish","type":"page","link":"https:\/\/sacredstudios.co.za\/index.php\/intake-consent-form\/","title":{"rendered":"Sacred Studios: Intake &#038; Consent Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"306\" class=\"elementor elementor-306\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0ad4a4a e-grid e-con-full e-con e-parent\" data-id=\"0ad4a4a\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-04a2562 elementor-widget elementor-widget-image\" data-id=\"04a2562\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/sacredstudios.co.za\/wp-content\/uploads\/2026\/05\/SS-Portrait@2x.png\" title=\"SS Portrait@2x\" alt=\"SS Portrait@2x\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-67c9061 elementor-widget__width-auto eael-hamburger--mobile elementor-widget-tablet__width-inherit eael_simple_menu_hamburger_disable_selected_menu_no eael-simple-menu-hamburger-align-right elementor-widget elementor-widget-eael-simple-menu\" data-id=\"67c9061\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-simple-menu.default\">\n\t\t\t\t\t<style>\n                        @media screen and (max-width: 767px) {\n                            .eael-hamburger--mobile {\n                                .eael-simple-menu-horizontal,\n                                .eael-simple-menu-vertical {\n                               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data-hamburger-icon=\"&lt;svg aria-hidden=&quot;true&quot; class=&quot;e-font-icon-svg e-fas-bars&quot; viewBox=&quot;0 0 448 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M16 132h416c8.837 0 16-7.163 16-16V76c0-8.837-7.163-16-16-16H16C7.163 60 0 67.163 0 76v40c0 8.837 7.163 16 16 16zm0 160h416c8.837 0 16-7.163 16-16v-40c0-8.837-7.163-16-16-16H16c-8.837 0-16 7.163-16 16v40c0 8.837 7.163 16 16 16zm0 160h416c8.837 0 16-7.163 16-16v-40c0-8.837-7.163-16-16-16H16c-8.837 0-16 7.163-16 16v40c0 8.837 7.163 16 16 16z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" data-indicator-icon=\"&lt;svg aria-hidden=&quot;true&quot; class=&quot;e-font-icon-svg e-fas-angle-down&quot; viewBox=&quot;0 0 320 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M143 352.3L7 216.3c-9.4-9.4-9.4-24.6 0-33.9l22.6-22.6c9.4-9.4 24.6-9.4 33.9 0l96.4 96.4 96.4-96.4c9.4-9.4 24.6-9.4 33.9 0l22.6 22.6c9.4 9.4 9.4 24.6 0 33.9l-136 136c-9.2 9.4-24.4 9.4-33.8 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" data-dropdown-indicator-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-angle-down&quot; viewBox=&quot;0 0 320 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M143 352.3L7 216.3c-9.4-9.4-9.4-24.6 0-33.9l22.6-22.6c9.4-9.4 24.6-9.4 33.9 0l96.4 96.4 96.4-96.4c9.4-9.4 24.6-9.4 33.9 0l22.6 22.6c9.4 9.4 9.4 24.6 0 33.9l-136 136c-9.2 9.4-24.4 9.4-33.8 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" class=\"eael-simple-menu-container eael-simple-menu--loading eael-simple-menu-align-center eael-simple-menu-dropdown-align-left preset-3\" data-hamburger-breakpoints=\"{&quot;mobile&quot;:&quot;Mobile Portrait (&gt; 767px)&quot;,&quot;tablet&quot;:&quot;Tablet Portrait (&gt; 1024px)&quot;,&quot;desktop&quot;:&quot;Desktop (&gt; 2400px)&quot;,&quot;none&quot;:&quot;None&quot;}\" data-hamburger-device=\"mobile\">\n                <ul id=\"menu-home-menu\" class=\"eael-simple-menu eael-simple-menu-dropdown-animate-to-top eael-simple-menu-indicator eael-simple-menu-horizontal\"><li id=\"menu-item-24\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-home menu-item-24\"><a href=\"https:\/\/sacredstudios.co.za\/\">Home<\/a><\/li>\n<li id=\"menu-item-25\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-home menu-item-25\"><a href=\"https:\/\/sacredstudios.co.za\/#exploration\">About<\/a><\/li>\n<li id=\"menu-item-251\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-home menu-item-251\"><a href=\"https:\/\/sacredstudios.co.za\/#approach\">My Approach<\/a><\/li>\n<li id=\"menu-item-26\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-home menu-item-26\"><a href=\"https:\/\/sacredstudios.co.za\/#booking\">Book a Session<\/a><\/li>\n<li id=\"menu-item-634\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-634\"><a href=\"https:\/\/sacredstudios.co.za\/index.php\/gallery\/\">Gallery<\/a><\/li>\n<li id=\"menu-item-27\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-home menu-item-27\"><a href=\"https:\/\/sacredstudios.co.za\/#contact\">Get in Touch<\/a><\/li>\n<\/ul>                <button class=\"eael-simple-menu-toggle\">\n                    <span class=\"sr-only \">Hamburger Toggle Menu<\/span>\n                    <svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-bars\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M16 132h416c8.837 0 16-7.163 16-16V76c0-8.837-7.163-16-16-16H16C7.163 60 0 67.163 0 76v40c0 8.837 7.163 16 16 16zm0 160h416c8.837 0 16-7.163 16-16v-40c0-8.837-7.163-16-16-16H16c-8.837 0-16 7.163-16 16v40c0 8.837 7.163 16 16 16zm0 160h416c8.837 0 16-7.163 16-16v-40c0-8.837-7.163-16-16-16H16c-8.837 0-16 7.163-16 16v40c0 8.837 7.163 16 16 16z\"><\/path><\/svg>                <\/button>\n            <\/div>\n            \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ec41fec e-flex e-con-boxed e-con e-parent\" data-id=\"ec41fec\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5874138 elementor-widget elementor-widget-heading\" data-id=\"5874138\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Sacred Studios: Intake &amp; Consent Form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5c4afae elementor-widget elementor-widget-heading\" data-id=\"5c4afae\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Practitioner: Else Roos (MA Art Therapy, UJ) <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d72b3be elementor-widget elementor-widget-heading\" data-id=\"d72b3be\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">Email: info@sacredstudios.co.za | Phone: 061 542 9133<\/h6>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7867fec elementor-widget elementor-widget-heading\" data-id=\"7867fec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h6 class=\"elementor-heading-title elementor-size-default\">HPCSA Reg: AT 0002275 | Practice No: 1326996 <\/h6>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6d89fc8 e-flex e-con-boxed e-con e-parent\" data-id=\"6d89fc8\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-091c8ef elementor-widget elementor-widget-shortcode\" data-id=\"091c8ef\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-275 forminator-design--material  \" data-forminator-render=\"0\" data-form=\"forminator-module-275\" data-uid=\"6a67e52319b95\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-275\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-275 forminator-design--material  \"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"275\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"material\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a67e52319b95\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Service Type:<\/span><\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-2-6a67e52319b95-label\"><label id=\"forminator-field-checkbox-2-1-6a67e52319b95-label\" for=\"forminator-field-checkbox-2-1-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Individual\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-2-1-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Individual<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a67e52319b95-label\" for=\"forminator-field-checkbox-2-2-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Minor (U\/18)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-2-2-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Minor (U\/18)<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a67e52319b95-label\" for=\"forminator-field-checkbox-2-3-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Couple\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Couple\" id=\"forminator-field-checkbox-2-3-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-2-3-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Couple<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a67e52319b95-label\" for=\"forminator-field-checkbox-2-4-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Group\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Group\" id=\"forminator-field-checkbox-2-4-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-2-4-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Group<\/span><\/label><label id=\"forminator-field-checkbox-2-5-6a67e52319b95-label\" for=\"forminator-field-checkbox-2-5-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Psychoeducational Workshop\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Psychoeducational-Workshop\" id=\"forminator-field-checkbox-2-5-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-2-5-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Psychoeducational Workshop<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a67e52319b95\" id=\"forminator-field-name-2_6a67e52319b95-label\" class=\"forminator-label\">Full Name &amp; Surname: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"John Doe\" id=\"forminator-field-name-2_6a67e52319b95\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a67e52319b95\" id=\"forminator-field-text-1_6a67e52319b95-label\" class=\"forminator-label\">ID Number: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6a67e52319b95\" id=\"forminator-field-text-9_6a67e52319b95-label\" class=\"forminator-label\">Your Age:<\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-12 \"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">Date of Birth:<\/label><div class=\"forminator-date-input\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-year_6a67e52319b95\" id=\"forminator-field-date-1-year_6a67e52319b95-label\" class=\"forminator-label\">Year<\/label><input type=\"number\" min=\"1\" name=\"date-1-year\" placeholder=\"E.g. 2000\" id=\"forminator-field-date-1-year_6a67e52319b95\" class=\"forminator-input\" data-field=\"year\" value=\"\" data-format=\"yy-mm-dd\" data-parent=\"date-1\" \/><\/div><\/div><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-month_6a67e52319b95\" id=\"forminator-field-date-1-month_6a67e52319b95-label\" class=\"forminator-label\">Month<\/label><input type=\"number\" min=\"1\" max=\"12\" name=\"date-1-month\" value=\"\" placeholder=\"E.g. 01\" id=\"forminator-field-date-1-month_6a67e52319b95\" class=\"forminator-input\" data-field=\"month\" data-format=\"yy-mm-dd\" data-parent=\"date-1\" \/><\/div><\/div><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-day_6a67e52319b95\" id=\"forminator-field-date-1-day_6a67e52319b95-label\" class=\"forminator-label\">Day<\/label><input type=\"number\" min=\"1\" max=\"31\" name=\"date-1-day\" value=\"\" placeholder=\"E.g. 01\" id=\"forminator-field-date-1-day_6a67e52319b95\" class=\"forminator-input\" data-field=\"day\" data-format=\"yy-mm-dd\" data-parent=\"date-1\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6a67e52319b95\" id=\"forminator-field-text-10_6a67e52319b95-label\" class=\"forminator-label\">First Language:<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a67e52319b95\" id=\"forminator-field-phone-1_6a67e52319b95-label\" class=\"forminator-label\">Contact Number: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_6a67e52319b95\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a67e52319b95\" id=\"forminator-field-email-1_6a67e52319b95-label\" class=\"forminator-label\">Email: <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_6a67e52319b95\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a67e52319b95\" id=\"forminator-field-textarea-2_6a67e52319b95-label\" class=\"forminator-label\">Residential Address:<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_6a67e52319b95\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a67e52319b95\" id=\"forminator-field-text-2_6a67e52319b95-label\" class=\"forminator-label\">Occupation\/Education:<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6a67e52319b95\" id=\"forminator-field-text-11_6a67e52319b95-label\" class=\"forminator-label\">Emergency Contact Name:<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_6a67e52319b95\" id=\"forminator-field-phone-3_6a67e52319b95-label\" class=\"forminator-label\">Emergency Contact Number: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-3_6a67e52319b95\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6a67e52319b95\" id=\"forminator-field-text-12_6a67e52319b95-label\" class=\"forminator-label\">Relationship:<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6a67e52319b95\" id=\"forminator-field-text-13_6a67e52319b95-label\" class=\"forminator-label\">General Practitioner (Name &amp; Contact):<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6a67e52319b95\" id=\"forminator-field-text-14_6a67e52319b95-label\" class=\"forminator-label\">Referred By:<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">IF THE CLIENT IS A MINOR (UNDER 18):<\/span><\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a67e52319b95\" id=\"forminator-field-name-1_6a67e52319b95-label\" class=\"forminator-label\">Primary Guardian Name: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a67e52319b95\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a67e52319b95\" id=\"forminator-field-text-3_6a67e52319b95-label\" class=\"forminator-label\">ID: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-3\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-3_6a67e52319b95\" id=\"forminator-field-name-3_6a67e52319b95-label\" class=\"forminator-label\">Secondary Guardian Name:<\/label><input type=\"text\" name=\"name-3\" value=\"\" placeholder=\"\" id=\"forminator-field-name-3_6a67e52319b95\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" autocomplete=\"name\" \/><\/div><\/div><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a67e52319b95\" id=\"forminator-field-text-4_6a67e52319b95-label\" class=\"forminator-label\">ID:<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6a67e52319b95\" id=\"forminator-field-phone-2_6a67e52319b95-label\" class=\"forminator-label\">Secondary Contact Number<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-2_6a67e52319b95\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a67e52319b95\" id=\"forminator-field-text-5_6a67e52319b95-label\" class=\"forminator-label\">Relationship(s) to Client <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a67e52319b95\" id=\"forminator-field-text-6_6a67e52319b95-label\" class=\"forminator-label\">School &amp; Grade: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-7\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-7\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">If Seeking Couple\u2019s Therapy <\/span><\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-4\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-4_6a67e52319b95\" id=\"forminator-field-name-4_6a67e52319b95-label\" class=\"forminator-label\">Partner Full Name: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-4\" value=\"\" placeholder=\"\" id=\"forminator-field-name-4_6a67e52319b95\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_6a67e52319b95\" id=\"forminator-field-text-15_6a67e52319b95-label\" class=\"forminator-label\">ID: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-4\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-4_6a67e52319b95\" id=\"forminator-field-phone-4_6a67e52319b95-label\" class=\"forminator-label\">Contact Number: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-4\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-4_6a67e52319b95\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"email-2\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-2_6a67e52319b95\" id=\"forminator-field-email-2_6a67e52319b95-label\" class=\"forminator-label\">Email: <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-2\" value=\"\" placeholder=\"\" id=\"forminator-field-email-2_6a67e52319b95\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6a67e52319b95\" id=\"forminator-field-text-16_6a67e52319b95-label\" class=\"forminator-label\">Relationship Status &amp; Duration: <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">CLINICAL HISTORY &amp; CONTEXT<\/span><\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a67e52319b95\" id=\"forminator-field-text-7_6a67e52319b95-label\" class=\"forminator-label\">Reason for seeking therapy at this time:<\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6a67e52319b95\" id=\"forminator-field-text-8_6a67e52319b95-label\" class=\"forminator-label\">Brief history of the concern:<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a67e52319b95\" id=\"forminator-field-textarea-1_6a67e52319b95-label\" class=\"forminator-label\">Have you received therapy before? If yes, please specify:<\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_6a67e52319b95\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:50px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Data Protection &amp; Secure Storage (POPIA &amp; HPCSA) <\/span><\/h2>\n<p><span style=\"font-weight: 400\">Sacred Studios is committed to the protection of your personal and clinical information. <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Secure Storage:<\/b><span style=\"font-weight: 400\"> I acknowledge and consent that all personal data, including online information, hardcopy documents, physical artworks, and digital photographs of artworks, are stored safely and securely. Virtual platforms and cloud storage (e.g., email or cloud drives) utilize relevant password protections.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Compliance:<\/b><span style=\"font-weight: 400\"> Records are maintained in accordance with the Protection of Personal Information Act (POPIA) and HPCSA ethical guidelines for health records.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Client Rights:<\/b><span style=\"font-weight: 400\"> In line with POPIA and the Promotion of Access to Information Act (PAIA), you retain the right to request access to, updates to, or the deletion of your personal information.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Retention:<\/b><span style=\"font-weight: 400\"> Clinical records are safely retained for the legally required period \u2013 6 years for adults, or until a minor client's 21st birthday \u2013 in compliance with HPCSA standards, before being securely destroyed.&nbsp;<\/span><\/li>\n<\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-3-6a67e52319b95-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-3-6a67e52319b95-label\" class=\"forminator-label\">I agree with the Data Protection &amp; Secure Storage (POPIA &amp; HPCSA) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-3-1-6a67e52319b95-label\" for=\"forminator-field-checkbox-3-1-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Yes\" id=\"forminator-field-checkbox-3-1-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-3-1-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-8\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-8\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Professional Policies &amp; Informed Consent<\/span><\/h2>\n<p><strong>Photography of Artworks, Process &amp; Academic Material<\/strong><\/p>\n<p><span style=\"font-weight: 400\">Photography of the artmaking process and\/or final products is a valuable tool for clinical reflection and the therapeutic narrative.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Pre-emptive Consent:<\/b><span style=\"font-weight: 400\"> By signing below, you provide initial, pre-emptive consent for photographs to be taken.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Circumstantial Nature:<\/b><span style=\"font-weight: 400\"> I understand that this consent is fluid. It may be revisited, restricted, or withdrawn at any time for specific artworks or sessions. I retain the right to decide whether any individual piece is documented.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Academic &amp; Research Use:<\/b><span style=\"font-weight: 400\"> Material from the therapy work may occasionally be used anonymously for training, research, or publication purposes, ensuring all identifying data is strictly omitted. <\/span><i><span style=\"font-weight: 400\">(Please note under \"Special Terms\" at the end if you wish to opt out of this specific academic use)<\/span><\/i><span style=\"font-weight: 400\">.&nbsp;<\/span><\/li>\n<\/ul>\n<p><b>Initial here to provide photography &amp; anonymous academic consent:&nbsp; {name-2}<\/b><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-4-6a67e52319b95-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-4-6a67e52319b95-label\" class=\"forminator-label\">I agree with the Professional Policies &amp; Informed Consent <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-4-1-6a67e52319b95-label\" for=\"forminator-field-checkbox-4-1-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Yes\" id=\"forminator-field-checkbox-4-1-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-4-1-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-9\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-9\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Financial Policy<\/span><\/h2>\n<p><strong>Photography of Artworks, Process &amp; Academic Material<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Payment &amp; Medical Aids:<\/b><span style=\"font-weight: 400\"> Sacred Studios is a cash-based practice. The practice is not contracted into medical aid schemes; clients are responsible for settling fees directly. Clients may independently claim back from their schemes depending on their specific options, though not all medical aids cover Arts Therapies. Fees are adjusted at the beginning of each calendar year.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Cancellations:<\/b><span style=\"font-weight: 400\"> Sessions cancelled with less than 24 hours' notice will be charged at the full rate, as professional time has been set aside. Please note that medical aids do not reimburse for missed or cancelled sessions.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Late Payments &amp; Collections:<\/b><span style=\"font-weight: 400\"> Late payments may incur interest charges. Accounts left unpaid timeously may be handed over for debt collection, and the client will be liable for any associated legal costs.&nbsp;<\/span><\/li>\n<\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-5-6a67e52319b95-label\"><span id=\"forminator-checkbox-group-forminator-field-checkbox-5-6a67e52319b95-label\" class=\"forminator-label\">I agree with the Financial Policy <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-5-1-6a67e52319b95-label\" for=\"forminator-field-checkbox-5-1-6a67e52319b95\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"Yes\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Yes\" id=\"forminator-field-checkbox-5-1-6a67e52319b95\" aria-labelledby=\"forminator-field-checkbox-5-1-6a67e52319b95-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Yes<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-10\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-10\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Clinical Boundaries &amp; Ethical Limits to Confidentiality<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400\"><b>General Confidentiality:<\/b><span style=\"font-weight: 400\"> Private therapeutic information is regarded as highly confidential. You have the right to ask questions about anything that occurs in your therapy at any point.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Legal &amp; Ethical Exceptions:<\/b><span style=\"font-weight: 400\"> The therapist may be legally or ethically obliged to break confidentiality and disclose information to relevant third parties under exceptional circumstances:&nbsp;<\/span>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">If there is a clear, serious risk of harm to yourself or another person.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">If there is reason to believe a child has been or is at risk of being harmed.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">In compliance with a valid court order or subpoena.&nbsp;<\/span><\/li>\n<\/ol>\n<\/li>\n<li style=\"font-weight: 400\"><b>Termination:<\/b><span style=\"font-weight: 400\"> Ideally, therapy terminates when both the client (or guardian) and the therapist agree that therapeutic goals have been achieved.&nbsp;<\/span><\/li>\n<\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-11\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-11\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Couples &amp; Group Specifics<\/span><\/h2>\n<ul>\n<li style=\"font-weight: 400\"><b>Couples:<\/b><span style=\"font-weight: 400\"> We understand that information shared in individual \"side-conversations\" may be brought into joint sessions if deemed clinically necessary by the therapist.&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Groups:<\/b><span style=\"font-weight: 400\"> I agree to keep the identities and personal stories of all group members strictly confidential.&nbsp;<\/span><\/li>\n<\/ul><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6a67e52319b95\" id=\"forminator-field-text-17_6a67e52319b95-label\" class=\"forminator-label\">Special Terms \/ Notes (Optional)<\/label><span id=\"forminator-field-text-17_6a67e52319b95-description\" class=\"forminator-description\">(Please indicate below if you have any specific restrictions or if you do not grant consent for anonymous research\/publication use)<\/span><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" aria-describedby=\"forminator-field-text-17_6a67e52319b95-description\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-12\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-12\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Formal Agreement &amp; Signatures <\/span><\/h2><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-16\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-16\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">Parental Consent (For Minors) <\/span><\/h2>\n<p><span style=\"font-weight: 400\">I\/We, the undersigned, confirm that I am\/we are the legal guardian(s) of the minor named above. I\/We consent to their engagement in Art Psychotherapy. I\/We understand that clinical details remain confidential between the therapist and minor unless a risk of harm is identified.&nbsp;<\/span><\/p>\n<p><b>Guardian Signature:&nbsp; {name-1}&nbsp; Date:&nbsp; 07\/27\/2026<\/b><\/p>\n<p><b>Secondary Guardian Signature:&nbsp; {name-3}&nbsp; Date:&nbsp; 07\/27\/2026<\/b><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-13\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-13\"><label class=\"forminator-label\">HTML<\/label><h2><span style=\"font-weight: 400\">General Consent (All Clients\/Guardians) <\/span><\/h2>\n<p><span style=\"font-weight: 400\">I enter this therapeutic relationship voluntarily. I have been informed of my rights, the nature of the creative process at Sacred Studios, and the policies regarding data storage, confidentiality limits, and financial responsibility. By signing below, I acknowledge that I have read, understood, and agreed to the terms of this contractual agreement.&nbsp;<\/span><\/p>\n<p><b>Client Signature:&nbsp; {name-2}&nbsp; Date:&nbsp; 07\/27\/2026<\/b><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-14\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-14\"><label class=\"forminator-label\">HTML<\/label><p><b>Guardian Signature:&nbsp; {name-1}&nbsp; Date:&nbsp;&nbsp; 07\/27\/2026<\/b><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-15\" class=\"forminator-field-html forminator-col forminator-col-12  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-15\"><label class=\"forminator-label\">HTML<\/label><p><b>Partner Signature:&nbsp; {name-4}&nbsp; Date:&nbsp;&nbsp; 07\/27\/2026<\/b><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6a67e52319b95\" id=\"forminator-field-text-18_6a67e52319b95-label\" class=\"forminator-label\">Person Responsible for Account (if different):<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6a67e52319b95\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"html-17\" class=\"forminator-field-html forminator-col forminator-col-6  form-html-label\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-17\"><label class=\"forminator-label\">HTML<\/label><p><strong>Date:&nbsp; 27\/07\/2026<\/strong><\/p><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\"><span>Submit<\/span><span aria-hidden=\"true\"><\/span><\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"6b8f56ec93\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/306\" \/><input type=\"hidden\" name=\"form_id\" value=\"275\"><input type=\"hidden\" name=\"page_id\" value=\"306\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/sacredstudios.co.za\/index.php\/intake-consent-form\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-beec839 e-flex e-con-boxed e-con e-parent\" data-id=\"beec839\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-8d19231 e-con-full e-flex e-con e-child\" data-id=\"8d19231\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-9d2c65e e-con-full animated-slow e-flex e-con e-child\" data-id=\"9d2c65e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;animation&quot;:&quot;none&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c4cf058 elementor-widget elementor-widget-image\" data-id=\"c4cf058\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/sacredstudios.co.za\/wp-content\/uploads\/2026\/05\/sacred-studios-graphic-painted-light.png\" title=\"sacred-studios-graphic-painted-light\" alt=\"sacred-studios-graphic-painted-light\" loading=\"lazy\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-124345d elementor-widget elementor-widget-heading\" data-id=\"124345d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Get In Touch<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-63115b2 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"63115b2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-529f820 e-con-full animated-slow e-grid e-con e-child\" data-id=\"529f820\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;animation&quot;:&quot;none&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7a2e2b5 elementor-widget elementor-widget-text-editor\" data-id=\"7a2e2b5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Email: <strong>info@sacredstudios.co.za<\/strong><\/p><p>Phone: <strong>061 542 9133<\/strong><\/p><p>Address:<strong> Honingklip, Krugersdorp<\/strong><\/p><p>\u00a0<\/p><p>HPCSA Reg: AT 0002275<\/p><p>Practice #: 1326996<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-25c3cff elementor-widget elementor-widget-text-editor\" data-id=\"25c3cff\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Sacred Studios<\/p><p><strong>Art Psychotherapy<\/strong><\/p><p>by Else Roos<\/p><p>\u00a0<\/p><p><strong>Where art meets the spirit<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e211f76 elementor-shape-circle e-grid-align-left elementor-grid-0 elementor-widget elementor-widget-social-icons\" data-id=\"e211f76\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-instagram elementor-repeater-item-c5523d2\" href=\"https:\/\/www.instagram.com\/sacredstudios_art\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Instagram<\/span>\n\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fab-instagram\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M224.1 141c-63.6 0-114.9 51.3-114.9 114.9s51.3 114.9 114.9 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132.1z\"><\/path><\/svg>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Home About My Approach Book a Session Gallery Get in Touch Hamburger Toggle Menu Sacred Studios: Intake &amp; Consent Form Practitioner: Else Roos (MA Art Therapy, UJ) Email: info@sacredstudios.co.za | Phone: 061 542 9133 HPCSA Reg: AT 0002275 | Practice No: 1326996 Get In Touch Email: info@sacredstudios.co.za Phone: 061 542 9133 Address: Honingklip, Krugersdorp \u00a0 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-306","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/pages\/306","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/comments?post=306"}],"version-history":[{"count":56,"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/pages\/306\/revisions"}],"predecessor-version":[{"id":855,"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/pages\/306\/revisions\/855"}],"wp:attachment":[{"href":"https:\/\/sacredstudios.co.za\/index.php\/wp-json\/wp\/v2\/media?parent=306"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}