Spiritual Coaching Intake Questionnaire and Waiver Form

Form is to be filled out completely prior to your first session. Signature will be collected at the first session. If you would rather download the form, click here.

For more information on Spiritual Coaching, click here.

WAIVER Details

Fee Structure per 50-minute session: Individuals: $115 -215. Couples: $255-475 Family TBD

*NOTE: During the intervening time between sessions I am available for 1 or 2 brief (10-15 minute) telephone conferences or by email. Couples are expected to call simultaneously.

Full payment is due at the time of each session. Accepted forms of payment are: website online (click here), cash, PayPal (revjeep@revjeep.com) or check payable to: Transformative Services

*Please note: Unfortunately, insurance companies do not cover spiritual coaching sessions.

Confidentiality: All information discussed in each session is confidential with three exceptions: (1) when a client poses a danger to themselves or others, (2) when requested by a court of law, or (3) for purposes of professional supervision (in which case, your name and identifying information will not be used).

Please be advised that disclosure of child abuse or suicide attempts must be reported by law.

Cancellation Policy:All cancellations require a 24-hour advance notification. Ten minutes grace into the appointment. After the ten minutes there is not enough time for a session. Client is responsible for full fee for missed or late session. Clients who are within the ten-minute grace period will be seen for the remainder of the 50-minute session, not to extend past the allotted time.

If you have any questions, contact Rev. Jeep at: 917-293-5592.