Detailed
Client
Intake

Please complete and submit this form and the memo of understanding.

MEMO OF

UNDERSTANDING

Personal Details

First name

Last name

Preferred Name/pronouns

Address

Phone

Occupation

Birthday

Month

Day

Year

Spiritual Background

Provide about 2-3 sentences per question. Feel free to use more space as needed.

What led you to seek spiritual direction at this time?

What do you hope to gain from Spiritual Direction?

Share a brief overview of your religious/spiritual background.

Are there any spiritual practices, people, or materials that are meaningful to you?

Please briefly describe your spiritual journey (What traditions, touchstones of joy and challenge have you experienced?)

Who is in your immediate/extended family? Which relationships are meaningful to you? Are there relationships that have a particularly positive or negative impact on you?

Please share anything about your mental, physical, or emotional health that you want me to know (including suspected or diagnosed neurodivergence). Self-discloser is voluntary.

Is there anything not addressed in these questions you would like to share?

Signature

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I have received, read, and signed the Memo of Understanding for Attentive Spiritual Care

Detailed Client Intake

Personal Details

Spiritual Background

Detailed
Client
Intake