NEW CLIENT INTAKE FORM

Let's Get to Know You

Please complete this confidential form before your first session. It helps Shirree understand your story and prepare to walk alongside you well.

Household (optional)

Only share what feels relevant -- this simply helps Shirree understand your context.

Consent to Coaching

I understand that Heart & Soul Belief Therapy LLC provides faith-based belief coaching through the Therapon model. This service is religious and educational in nature and is not licensed mental health counseling, psychotherapy, psychiatric care, or medical treatment, and is not subject to state licensure or regulation as a clinical health service.

I understand that the methods used are nonmedical and may include prayer, biblical guidance, spiritual encouragement, and scriptural study, and that Shirree Robinson is a Certified Belief Specialist through Therapon, not a licensed therapist or physician.

I understand that if I am experiencing a mental health crisis or need clinical or medical care, it is my responsibility to seek help from a licensed professional or emergency services.