Intake Form

Loss and change are normal and natural. Experiencing a loss may feel devastating and traumatic such as when a death or divorce occur. Change can also be exciting in its uncertainty like when we start a new business, graduate college, or begin a new relationship.

Loss and change create conflicting feelings. Sometimes loss prompts transformation, expansion, reconnection, and healing. We are not meant to grieve alone, and support in one form or another provides the possibility for healing. Some losses are so enormous and life altering that they prompt us to seek professional support in order to integrate these losses into our lives. Compassionate support allows us to safely step into an in-between place, the liminal territory, where healing and possibilities are revealed.

I am a guide through grieving and offer a Rite of Passage work for individuals seeking healing, integration, or transformation after experiencing a difficult, intense, and/or painful loss. This work typically occurs over 10-12 weeks following a flexible curriculum.

If you are interested in setting up an appointment with me, please complete the following forms. After I have received your forms, I will contact you to schedule our first session. If you have any questions as you are completing the forms or about the process, please text or call me at 512-992-8725.

Our Agreement

  1. I agree to engage in personal work with Jennifer Sabatier, and I can discontinue at any time. If at any point, you need to stop the work please honor that moment in a conversation with me. Even if it is just a feeling or concern, it is part of the work, and our relationship can hold the discussion and outcome.

  2. I understand that if I cancel 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.

  3. I understand that this personal work around grief and loss 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.

  4. I understand that the nature of personal work may delve into deeply emotional material.

  5. I understand that confidentiality is honored, and no personal information or details of what

    occurs in sessions will be shared with others.

  6. If any issues arise that fall outside the scope of Jennifer’s ability or skill, she will offer

    professional referrals.

  7. I agree to pay materials fees if applicable (books/youth session materials/art supplies).

  8. I agree to pay a fee of $150 per session/hour (unless otherwise negotiated). Youth session

    fees vary based on age/time.

  9. I agree to keep an active debit/credit card on file to be charged following my sessions or for a missed appointment. I understand I can pay by cash, Venmo, or check as an alternative at the end of my session.

  10. I agree to the following Copyright Agreement

I understand that ALL materials in th NewBloomz modules 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:

Checking the box “I Agree” indicates that I agree 1) to the above outlined parameters and copyright agreement and 2) to enter and keep an active card on file when I receive my first invoice: