ESSENTIALS Client SOUL ENQUIRY INTAKE / INFORMED CONSENT 2026

Please verify that you are human*

This form is CONFIDENTIAL. Only I (Karen) gets to read it.
Be brief and use point form if you wish.

Your Name*

First NameLast Name

Is this session for a child? Please add full name of child and current age.

Your mobile/phone*

Email*

example@example.com

Your Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

What do you hope for in undergoing Soul Enquiry sessions? (intention)*

Please read, sign and submit to complete.

INFORMED CONSENT CONFIDENTIALITY and DUTY OF CARE

Everything you share with me in the course of our work together will be treated as highly confidential. I only make very brief notes and only if appropriate.

However, there are a few rare circumstances in which I may be required to break confidentiality in the case of DUTY OF CARE -
- If I believe that you or anyone else is at risk of harm I may need to inform a third party.
- If you become involved in a court case, the court has the power to ask me to hand over my file/s.
As mentioned, these are rare circumstances.

Ethically I partake in some clinical supervision and peer support, and it may be that I may discuss some of the facts relating to you, but without revealing your identity or whereabouts. This is to ensure that you are getting the best support.

Any other disclosure - such as to another practitioner or anyone else - requires your written consent.

Full Terms and Privacy here www.theheartofus.au/privacy-terms

Today's Date*

Date

Signature type name*

First NameLast Name

Signature - please sign*