Christian Counseling Intake Form
Thank you for choosing Nicole Sewell's Christian counseling services. Your responses to the following questions will help us understand your unique needs and provide you with the best possible support. All information provided will be treated confidentially.

CLIENT DETAILS

Briefly describe the primary reasons for seeking Christian counseling at this time.

EMERGENCY CONTACT INFORMATION

Mental Health History:

Write None if never received therapy.

Family Background:

FINAL STEPS

Privacy Notice and Confidentiality Policy

Welcome to Nicole Sewell Transformational Coaching, Christian, and Pastoral Counseling Services.

We are committed to maintaining the privacy and confidentiality of your personal information. This notice outlines our policies regarding the collection, use, and protection of your information.

Confidentiality:

  1. Scope of Confidentiality:
    • All information shared during counseling sessions, both verbal and written, is strictly confidential. This includes any personal, spiritual, or medical information disclosed during the course of counseling.
  2. Exceptions to Confidentiality:
    • Confidentiality may be breached in the following circumstances:
      • Imminent danger to yourself or others.
      • Suspected child or elder abuse.
      • If a court order or legal obligation requires the disclosure of information.
  3. Communication Limits:
    • We cannot guarantee the confidentiality of information transmitted via email or online platforms. Please use discretion when communicating electronically.

Information Collection and Use:

  1. Client Information:
    • We collect information necessary for providing counseling services, including personal, family, and medical history. This information is securely stored and only accessed by authorized personnel.
  2. Storage and Security:
    • Client records are securely stored both in physical and electronic formats. We employ industry-standard security measures to protect your information from unauthorized access.

Your Rights:

  1. Access to Information:
    • You have the right to access and review your personal information. Any corrections or updates can be requested through formal written communication.
  2. Retention of Records:
    • Client records are retained for a period specified by legal and ethical standards. After this period, information will be securely destroyed.

Consent:

  1. Informed Consent:
    • By engaging in Christian, Pastoral counseling or coaching services with Nicole, you are providing informed consent for the collection, use, and storage of your personal information as outlined in this policy.
  2. Changes to Policy:
    • This privacy notice may be updated periodically. Clients will be notified of any significant changes.

Contact Information:

If you have any questions or concerns about this privacy notice and confidentiality policy, please contact us at coach@nicolesewell.com 

Your well-being is our priority. Thank you for choosing Nicole Sewell as your partner for transformation and your faith-based counseling needs.