DISCOVERY FORM If you need at anytime to save and continue later please go to the end of the form.

  • Informed Consent

  • I, ___COMPLETE NAME BELOW _____, have been informed by Kris Reece LLC that spiritual guidance will be provided, that this agreement shall govern the professional relationship between the parties, that any parties, (if negotiations are not satisfactory, then the parties agree to mediate any differences with a mutually acceptable third – party mediator, considering first a member of the board of Kris Reece).  In the event of a lawsuit, the client may assume all the costs of litigation including adjunct costs and fees, and all attorney fees.
  • Confidentiality:  This ministry operates under the clergy / client confidentiality privilege which means that communication between the client and minister of counseling is confidential.  However, there are some exceptions when this privilege may be broken by the counselor.  These include the threat of serious harm to self or others, child abuse, abuse to the elderly or disabled, suicide or when otherwise required by law.

    Fees and Billing:  Payment may be made with cash, check or credit card.  A $30.00 fee will be applied to all NSF payments.  All payments must be rendered at time of or prior to service

    Appointment Time:  Kris Reece LLC schedules appointments in such a way as to insure your reserved time.  If you need to cancel or reschedule, 24 hours notice is required.  Without 24 hours notice, the full session rate will be charged.  No shows are charged the full session rate.  Please be on time to maximize your session time as sessions begin and end at scheduled times.  All client sessions are 50 minutes.

    Additional Charges: Between session contact should be made through brief emails.  Please limit texting to scheduling questions.  Longer emails and additional document reading or calls outside the session will be charged in 15 min intervals (minimum) at a rate of $45 per 15 mins

    Assignments:  In an effort to enjoy the benefits of counseling/coaching, homework may be assigned and we encourage you to complete all homework to the best of your ability, as this will contribute greatly to your progress and success.

    Counseling/Coaching Agreement:  I understand and of my own free will accept and agree to abide by this Informed Consent agreement as presented.  I also agree to release all liability, in any form, that may be charged against employees or volunteers by me or my estate.  I understand my personal responsibility to maintain confidentiality, and that bringing a third party in the counseling appointment may waive the confidential communication privilege during that session.

  • Your Expectations for Counseling

  • Evaluate the following statements based on how important they are to you personally. On a scale from 1 – 10, 1 being the least important and 10 being the most important.

  • Counseling Consultation

    The information contained below is to allow us to more quickly understand you and your reason for requesting counsel and to enable us to help you more expediently. Please fill out all forms as completely as possible. All information is held in the strictest of confidence and cannot be divulged without your permission.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Personal History

  • PastPresent
    Mood highs or lows
    Weight loss or Gain
    Appetite Changes
    Drug Use
    Alcohol Use
    Cigarette Use
    Irritability
    Excessive Stress
    Crying Spells
    Hallucinations
    Confusion
    Depression
    Low Self-Esteem
    Compulsion
    Lack of Motivation
    Indecisiveness
    Loss of Memory
    Fantasizing
  • PastPresent
    Insomnia
    Excessive Worry
    Difficulty Concentrating
    Hearing Unseen Voices
    Frequent Loss of Temper
    Acting out Violence
    Frequent Employment Changes
    Phobias or Fears
    Blaming other Frequently
    Lack of Sexual Awareness
    Spiritual Confusion
    Thoughts of Suicide
    Inability to Express
    Occult Involvement
    Personal Sexual Abuse
    Physical Abuse of Children
    Physical Abuse of others
  • Date Format: MM slash DD slash YYYY