Intake Forms

Please complete and submit the following forms. After I have received your forms, we will review them. If there are no concerns, we will schedule your overnight and the other preparatory sessions, and collect a deposit to reserve your overnight intensive session. If you have any questions as you are completing these forms or about the process, please text or call me.

our Agreement

I agree to engage in initiation, personal growth, and transformational work with Jennifer Sabatier, and I can discontinue at any time. If at any point, I need to stop the work please honor that moment with a conversation. Even if it is just a feeling or concern, it is part of the work, and our relationship can hold the discussion and outcome.
I understand that if I cancel an appointment for a non-emergency reason or do not show up for an appointment for a non-emergency reason with less than 24 hours notice, Jennifer reserves the right to charge me for the cost of the session.
I understand that this personal work is not therapy. If at any time I become aware that I require support from a licensed professional, I will let Jennifer know immediately, and she will offer referrals. Likewise, if any issues arise that fall outside the scope of Jennifer’s ability or skill, she will offer professional referrals.
I understand that the nature of personal work may delve into deeply emotional material. I understand that it is necessary for both my safety and depth of my experience that I be completely honest with Jennifer throughout our work together.
I understand that confidentiality is honored, and no personal information or details of what occurs in sessions will be shared with others unless prior permission has been granted.
I understand that, generally, the personal facilitation work includes a program of 3 preparation sessions, one overnight session, and one integration session. The integration session will occur about 1-2 weeks following the overnight appointment.
At any point, Jennifer or I can decide to stop our work together or increase the amount of preparation or integration sessions.
I am embarking on this program of my own free will and understand there are both physical and psychological risks associated with the practices and facilitation sessions. I hereby release Jennifer and her associates from any and all responsibility for the inherent risks involved in the program.
I agree to pay a fee of $100 (unless otherwise negotiated) per hour for a minimum of three preparation and integration sessions. If my session time exceeds an hour, I will pay a prorated fee for the additional time. Payment can be made via Square/cash.
I agree to keep an active debit/credit card on file to be charged following my preparatory and integration sessions or for a missed appointment. I understand I can pay by cash or check as an alternative at the end of my session.
At the start of my overnight intensive initiation experience, I agree to provide a cash or Venmo payment that includes:
$100 (cash/Venmo) for the overnight session at Owl’s Nest which includes dinner, breakfast, coffee/tea/snacks, and use of pool (weather permitting).
$800 for two supporters providing various modalities including yoga, reiki, energy work, eidetic imagery.
(OPTIONAL) $400 for an additional supporter providing modalities including live sound/singing bowls, water communication, yoga therapy
(OPTIONAL) $400 for an additional supporter providing modalities including cranial-sacral, massage, intuitive healing and energy support

I agree to the following Copyright Agreement

I understand that ALL materials and modules in the Rite of Passage Initiation and Transformative process are copy-written materials. I understand that these materials are for my personal development ONLY, and:

I may NOT utilize the materials for professional use;
I may NOT alter or modify the modules without written permission;
I may NOT distribute the password or modules to anyone else for profit or otherwise.

agreement Acknowledgment

Name

First Name

Last Name

My typed name below indicates my agreement to the above outlined parameters and copyright terms. (Type Name in Box)

Date

YYYY

Client Information

Name

First Name

Last Name

Birth Date

YYYY

Phone

(###)

###

####

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address (if different from Home)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact (name and phone)

What event or events brought you to this work?

Current medications

Primary Care Physician and Phone Number

List all psychological conditions or diagnoses

List all physical conditions or diagnoses

Past/Current psychotherapy/counseling; type of therapy and names of therapist

Other types of therapies, energy, or body work

Are you pregnant, chance you may be pregnant, or are you planning to become pregnant? (If yes, explain.)

Describe your family lineage/ancestry (traditions, culture, religions):

Describe your early childhood experiences (who raised you, who lived in your home, traumas, divorces, moves):

Describe significant experiences from your adult life (major life changes, losses, accidents, trauma, etc.):

What are your intentions in pursuing this work?

Do you have any specific questions for which you are seeking answers? If so, what are the questions?

What are some of my fears regarding this work and what might it bring up?

What changes would I like to make in my life right now?

What are some activities that make me happy or calm?

Some struggles or challenges that I am currently working through or experiencing include:

Who is someone living or dead that you trust completely and/or is a source of unconditional love and support? (Please elaborate about the relationship below.)

What place or places support or comfort you? (Please elaborate in the space below.)

What belief systems offer you support? (Please elaborate below.)

Do you have a friend, family member, or colleague that you feel safe talking to about the nature of this personal work and the experience you may have? If so, please elaborate about that relationship below.

Are there any additional details you would like me to know?

PAYMENT INFORMATION: Name on the Credit Card

Credit/Debit Card Number (to keep on file with option to pay another way at the end of your session):

Expiration Date

Security Code

PERMISSION TO CONSULT I give Jennifer Sabatier permission to consult and share relevant information from these forms and from our sessions with Alma Rominger and any Additional Supporters associated with this specific personal work. I give permission for information and details related to and for the specific purposes of supporting my transformational process. I understand that Jennifer and Alma and their colleagues work in partnership to support the intensive overnight sessions. Sharing the necessary details will provide a safe, supported, experiential session. Jennifer and Alma and their colleagues will not share any information from the sessions or the intensive overnight session with others. My typed name below indicates that I agree to the above permission to consult. (Type Name In Box.)