GETTING STARTED FORM FOR SPIRITUAL DIRECTION

GETTING STARTED FORM FOR SPIRITUAL DIRECTION

THIS INFORMATION LEGALLY WILL BE KEPT COMPLETELY CONFIDENTIAL. THIS FORM WILL TAKE BETWEEN 7 TO 10 MINUTES TO COMPLETE.
Name*

First NameLast Name
What are your preferred pronouns? *
Email*
example@example.com
Contact Number*
Please enter a valid phone number.
Birthdate*

MonthDayYear
Date
Spouse/Partner's Name
Occupation:*
Organization*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLEASE LIST YOUR CHILDREN BELOW.
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SPIRITUAL DIRECTION QUESTIONS
Have you been in spiritual direction in the past?*

YesNo
If yes, please describe:

0/100
What are your expectations of spiritual direction?*

0/100
Why are you seeking direction at this time?*

0/100
As it relates to spiritual matters, what do you fear?*

0/100
What do you seek from KYND as your director?*

0/100
Do you use a journal?*

YesNo
Briefly describe any professional psychological help you have received, if any:*

0/100
Describe your early life, your relationship with parents and/or significant people:*

0/100
QUESTIONS ABOUT YOUR SPIRITUAL JOURNEY
I would describe my relationship with Spirituality as:*

0/100
How do you meet and interact with your higher power (i.e. God, Allah, Source, Divine Mind, etc.)?*

0/100
How does your higher power view you?*

0/100
CONFIDENTIALITY INFORMATION AND RELEASE
Information shared in spiritual direction sessions is confidential and will not be discussed or released to anyone, except in cases where there is sufficient casue to believe that a life is in danger, or when you present with suicidal ideation and a plan for suicide completion. In addition, in an attempt to gain perspectives and ideas as to how best to help you reach your goals, I may meet with other professional spiritual directors regarding supervision for our sessions, but will not identify specific information being disclosed. Spiritual Directors are also required by law to report child abuse, child sexual abuse, elder abuse, or intentions to harm self or others. If you have any questions or concerns about our confidentiality policy, please do discuss the policy with us before signing below. By signing below you are accepting the confidentiality policy, its limits and exceptions.
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SPIRITUAL DIRECTION AGREEMENT
Following are the guidelines for a spiritual direction relationship:
- It is understood that the relationship pertains to and concerns the spiritual life of the directee. It does not directly concern itself with psychological counseling, psychotherapy, or medical practice of any kind.
- The Spiritual Direction fee is $100 per session due 24hrs prior to the session. If the directee is a no show or cancels the day of, the fee will still be charged to the account. Please make cancellations 24hrs in advance.
- Each session will last 60 minutes, beginning at the mutually agreed upon time.
- Notification should be given within twenty-four hours if an appointment cannot be kept by either party. Without such notification directee will make a payment for the usual fee.
I understand the above and agree to the terms set forth.
Signature

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Date

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Date
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GETTING STARTED FORM FOR SPIRITUAL DIRECTION

PLEASE LIST YOUR CHILDREN BELOW.

SPIRITUAL DIRECTION QUESTIONS

QUESTIONS ABOUT YOUR SPIRITUAL JOURNEY

CONFIDENTIALITY INFORMATION AND RELEASE

SPIRITUAL DIRECTION AGREEMENT

Congrats! You made it to the end of the form!