Spiritual Direction Intake Form Please complete and submit this form, answering all questions you are comfortable with, within 48 hours of our first spiritual direction session. Thank you! — Melissa Auten Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Birth Date Marital Status Single, Married, Domestic Partner, Divorced, Widowed Employment Status Full Time or Part Time & Type of Work, Unemployed, Retired Religious Affiliation or Religious Body (if applicable): Church Attendance/Religious Observation (if applicable): (Type of Service/Gathering; Weekly, Monthly, Occasionally, Never) What has your spiritual journey been like up to this point? How much time do you presently give, on average, to your inner life; and what, if any, spiritual disciplines do you practice on a regular basis (e.g., prayer, meditation, journaling, silence, study, dream work, etc.)? Are there any persons, groups, videos, podcasts, or publications that nourish you spiritually? What is your previous experience with spiritual direction, counselling, or therapy? Do you have any physical or psychological health problems? Please describe briefly. Are you experiencing a crisis in your life at this time? Please describe briefly. What is your motivation for seeking spiritual direction at this time? Thank you!