Spiritual Direction Intake and Agreement

Spiritual Direction Intake and Agreement

Thank you for your interest in spiritual direction with Naoma Riordan. This intake form will help me understand what you are seeking, learn about your spiritual background and preferences, and determine whether individual or group spiritual direction may be an appropriate fit.Submitting this form does not guarantee acceptance, enrollment, or the scheduling of a spiritual direction session. Availability, scheduling, the scope of spiritual direction, and our mutual sense of fit will all be considered before services begin. If I believe your needs would be better supported by another spiritual director or a different type of professional, I may recommend alternative resources.By submitting this form, you confirm that the information you provide is accurate to the best of your knowledge and give Naoma Riordan permission to contact you by the method you select regarding your inquiry, possible scheduling, and spiritual direction services. Your information will be treated respectfully and used only for purposes related to your request.Completing this form does not obligate you to begin spiritual direction. It simply allows us to take the next step in determining whether working together would be appropriate and supportive.
Participant Information
Full legal name

First NameMiddle NameLast Name
Preferred name
Pronouns
Date of birth

MonthDayYear
Date
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email address
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred contact method
Emergency Contact
Emergency contact name
Emergency contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to emergency contact
Spiritual Background
How would you currently describe your spiritual life?
Religion, denomination, faith tradition, or spiritual community
Current involvement in a church, temple, mosque, spiritual community, or other faith-based organization
What spiritual practices are currently meaningful to you?
Have you previously participated in spiritual direction?
What was helpful or unhelpful about that experience?
Direction Focus and Preferences
Questions, transitions, decisions, losses, or areas of discernment you would like to explore
What would help spiritual direction feel meaningful and supportive to you?
Spiritual words, images, practices, or approaches you especially welcome
Spiritual words, images, practices, topics, or approaches you would prefer that I not use
Anything that might make this space feel uncomfortable or unsafe for you
Anything else you would like me to understand before our work begins
Arrangements and Scheduling
Spiritual direction arrangement
Preferred meeting format
Preferred individual-session frequency
General availability
Scheduling limitations or preferences
Fees and Payment
Payment Arrangement
Preferred Payment Method
Agreements and Acknowledgments
32. I understand that fees are due as agreed and may be adjusted only with notice.
33. I understand that if I need to cancel or reschedule, I will give as much notice as possible.
34. I understand that missed appointments may still be charged unless otherwise agreed.
35. I understand that spiritual direction is not a substitute for professional mental health, medical, or legal care.
36. I understand that confidentiality will be maintained except where disclosure is required by law or needed to prevent harm.
37. I understand that personal information will be handled in accordance with applicable privacy practices.
38. I understand that I may withdraw from spiritual direction at any time.
39. I understand that the director may also end or pause sessions if appropriate.
40. I understand that I am responsible for my own choices and actions during and after sessions.
41. I understand that I am encouraged to communicate openly about concerns, expectations, or boundaries.
42. I understand that I have had the opportunity to ask questions and receive answers before agreeing.
43. I acknowledge that by continuing, I indicate my agreement with the above statements.
Signature and Agreement
Participant's Printed Name
Participant's Signature
Date (Participant)

MonthDayYear
Date
Naoma Riordan's Signature
Date (Naoma Riordan)

MonthDayYear
Date
Agreed Exceptions or Special Arrangements
Participant Initials
Naoma Riordan's Initials
Should be Empty: