Request for referral

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Complete the intake form, and a Qualified or Certified HeartSync Minister will reach out to you directly. If you wish for a different minister, simply email info@heartsyncministries.org or heartsyncinfo@gmail.com

The more information you can include, the better I will be able to refer you.

If you are completing this form simply to as a question, please just email Sarah Ann directly at one of the above email addresses.

Email *

Name (first and last) *

Phone number (including country code)

Preferred method of contact:

Phone call

Text

Other:

Clear selection

City, State, and Country (time zone is always helpful too) *

What kind of session are you open to? *

in-person only

online (zoom or another video conferencing application)

either but in-person preferred

either with no preference

The AVERAGE cost of a HeartSync Session is $150 per session. (Ministers may charge more or less based on length of time for session, skill level, etc.) Will you be able to commit to that financial cost? *

Yes

Other:

Any other comments, preferences, or concerns we should know about?

Please note that if you are seeking a licensed clinician or if you are needing someone who takes insurance, we may not be able to accommodate your request there are very few available at this time as many of them have full schedules and are not taking new referrals.

I understand and accept the Terms and Conditions (outlined on the website) *

Yes

No, please disregard my request.

Required

A copy of your responses will be emailed to the address you provided.

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