Novo-RTD Spiritual Consultation Intake Form
Please answer the survey below to help us better understand who you are, what's your context, and to design a spiritual consultation for you. All your answers and the content of your Spiritual Consultation will be held in appropriate confidence, within the confidentiality guidelines of Novo policy, and the Code of Ethics of the ESDA (see details here). 
First & Last Name *
Email Address *
Purpose of Spiritual Consultation *
What do you hope to gain from Spiritual Consultation?  
Are you currently in any form of counseling or psychotherapy?  *
Previous Experience with Soul Care *
Have you previous utilized the services of any Soul Care provider (Counseling, Psychotherapy, Support Group, Spiritual Direction, Life Coach, Mentor)? If so how long? How would you describe your experience? Were you pleased with the experience, overall? Would you say that your experience was successful? Why, or why not?  
Preference of Provider:  *
Please indicate if you have a strong preference that your Spiritual Director/Coach be: 
Preferred Providers *
Please list 1-3 preferred providers from the "Spiritual Providers Director"   
Novo Fund/Account Number *
Once you schedule your first session with your Director/Coach, a "deposit" of $50 will be deducted from your Novo account, and will be returned in full only after you submit the evaluation form at the end of the Consultation.
Referring Novo Supervisor or Provider: *
Please indicate the name of the Novo Supervisor or Provider, who recommended that you for a Spiritual Consultation. Or mark "Self" or "None" if you are seeking a Consultation on your own initiative.
Where do you live? *
Enter the City, State/Province, Country where you reside
Novo Division *
Let us know what part of Novo you serve in: 
Required
Ministry status *
Choose the best description of your current status in Novo.
Novo Team Name and direct Supervisor *
Please indicate the Name of the Team you serve with in Novo, and the Name of your direct Supervisor. 
Educational Background *
Please indicate the diplomas and degrees you have completed, along with the year you completed them, or expect to complete them.  
Conversion Experience *
Please indicate how many years since your conversion to Christ, and briefly describe the circumstances through which  you became a Christian?
Church Attendance *
What is the full name of the church you attend regularly. If none, write: "None"
Church Affiliation *
Please indicate the full name of the denominational affiliation of your church.
Ministry Involvement *
Please indicate the main ministry or ministry activities that you have been actively involved serving in during the past year.
How long have you been in your current Ministry? *
Enter the number of years that you have been in the Ministry Status indicated above
Soul Care Training *
Indicate what program(s) or training in Soul Care you have completed, if any:
Required
Marital Status *
Required
Family of Origin *
What would you like your Spiritual Director/Coach to understand about your Family of Origin (in which you grew up) that might be pertinent to the Consultation?
Current Family Circumstances *
What would you like your Spiritual Director/Coach to know about your Current Family circumstance (in which you presently live)?
Spiritual Condition *
Choose the option(s) that best describe the present condition of your soul (choose all that apply)
Required
Current Spiritual Practices *
Indicate the Spiritual Practices that are a regular and intentional part of your personal rhythms (choose all that apply):
Required
Prayer Life *
Choose the statements that apply to your current, regular life of prayer (choose all that apply):
Required
Dominant Emotions *
Indicate the dominant emotions that you most commonly experienced in the past few weeks or months (choose 1-4 options):
Required
Personality Test Results *
Have you taken any Personality Tests? Which one(s)? How long ago? What were the results? (For example: Myers-Briggs, DiSC, Enneagram?):
Greatest Challenges *
What are three of your greatest challenges at present? (whether related to: relationships, family, marriage, work, finances, physical health, emotional health, psychological health, spiritual health, or your relationship with God).
Greatest Joys *
What are the three greatest joys of your life right now?
Commitments & Conditions:  *
Required
Please Click "Submit" below and Thank You!
Thank you for filling out this Intake Form for a Spiritual Consultation. You will hear back from the Consultation Coordinator within a week.
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