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Spiritual Direction - Client Intake
Please fill out the following carefully and as thoroughly as possible. This will save time when we have our first meeting and allow us to accomplish as much as possible right off the bat! All information on this form will be subject to our privacy policy here:
https://rebrand.ly/DHPrivacy
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First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
May we email you (this is regarding privacy in case you share accounts)?
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Yes
No
Cell Phone
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Your answer
May we leave a message if you are unavailable (this is regarding privacy in case you share a phone)?
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Yes
No
Address - Street
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Your answer
Address - City
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Your answer
Address - Province,/State
Your answer
Address - Zip/Postal Code
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Your answer
Address - Country
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Your answer
Birthday month (spell fully - January, February, etc)
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Your answer
Birthday Date (number only - 1, 5, 27, etc)
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Your answer
Have you been in Spiritual Direction in the past?
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Yes
No
What are the biggest changes you want to make in your life in the next 4 months?
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Your answer
What are your expectations of spiritual direction?
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Your answer
Why are you seeking direction at this time?
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Your answer
As it relates to spiritual matters, what do you fear?
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Your answer
What are you hoping I'll provide for you in spiritual Direction?
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Your answer
Briefly describe any professional psychological help you have received, if any:
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Your answer
I would describe my relationship with God as:
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Your answer
Describe how you meet and interact with God:
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Your answer
How do you believe God sees you?
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Your answer
How would you describe God?
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Your answer
Is there anything else you'd like me to know?
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Your answer
Now, about the spiritual direction...
I agree to the following terms
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I agree to be as honest and open as I am capable.
I agree to make my spiritual direction calls from a safe, private place of freedom and comfort (not the car or with children to care for, for example).
I have read and agree to the Terms and Conditions here:
https://rebrand.ly/QCTAC
I have read and agree to the Privacy Policy here:
https://rebrand.ly/DHPrivacy
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