Care & Spiritual Direction Intake Form

Personal Information

Date

Relationship Information

Church Information

Ex. Name of Small Group Leader

Purpose of Care

Confidentiality

Information about care and spiritual direction is confidential and will not be discussed or released to anyone, except as noted below. The exceptions to this policy are as follows: In general, but not always, we discourage the keeping of secrets between family members. It is our view that secrets, such as past sexual abuse, unwanted pregnancies, adulterous affairs, etc. are more problematic when kept secret than when dealt with in an honest and appropriate manner. Please note that we are required by law to inform family members, the police, and others when there is sufficient cause to believe that a life is in danger, or when you appear suicidal. We are also required by law to report child abuse, child sexual abuse, elder abuse or intentions to harm 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, it’s limits and exceptions. In addition, in an attempt to gain perspectives and ideas as to how best to help you reach your goals, Soul Care counselors may meet with each other or their professional supervisor regarding their clients, but without identifying information being disclosed.

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