Spiritual Direction Intake Form

This form is for folks interested in spiritual direction. Please fill out the form to the best of your ability allowing yourself to feel through the answers and have no judgement for questions left unanswered. Sessions are generally $1 per minute but spaces are available for lower cost when needed.

Name

First Name

Last Name

Email

Phone

(###)

###

####

City, State (For timezone purposes!)

What services are you interested in?

60 Minute Session ($60)

90 Minute Session ($90)

Preferred Start Date

MM

DD

YYYY

How often would you like to meet? Preferred duration of our meetings (ie. 3 months, 1 year, etc)

Have you ever participated in spiritual direction before? If so, please describe your experience.

What would you like to gain from spiritual direction?

How often do you take time for your spiritual practices? What form(s) does it take?

Briefly describe your relationship with Spirit. (You may refer to Spirit in a very specific way, Please feel free to do so in this space!)

Any questions for me? Anything additional you'd like me to know?

Emergency Contact: Name, Relationship to You & Number

Confidentiality Agreement

I value your privacy and will honor that privacy by keeping our spiritual direction sessions confidential. The exception to that confidentiality would be if you expressed that you had (or intend to) hurt yourself or someone else, especially an elder, a child, or person who depends on you or others for care.

Click here to acknowledge and agree to Confidentiality Agreement

Spiritual Direction Intake Form

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