Personal Information

Emergency Contact Information

Regarding Spiritual Companioning

Privacy Information & Mandatory Reporting

Information shared in spiritual direction, companioning and soul care sessions is confidential and will not be discussed or released to anyone, except in cases where there is sufficient cause to believe that a life is in danger, or when you appear suicidal. 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 and companions regarding supervision for our sessions, but will not identify specific information being disclosed. Spiritual directors and companions 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 reservations about the policy in regard to confidentiality, then the policy should be discussed before signing below. By signing below you are accepting the confidentiality policy, its limits and exceptions.

Spiritual Companioning Agreement

• 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.

• My fee for services is for each spiritual direction appointment.

• Each session will last 50 minutes, beginning at the mutually agreed upon time.

• Notification should be given within twenty-four (24) hours if an appointment cannot be kept by either party. Without such notification, directee will plan to make their fee for services gift as usual.

• Spiritual direction may be discontinued at any time, by either party. Courtesy would require that advanced notice be given.

• An evaluation of the relationship may be made about every 6 months.

• I understand the above and agree to the terms set forth.