90-Minute Virtual Session Intake Form and Acknowledgment, Authorization, and Consent Agreement.

PRICING $100

PLEASE READ THOROUGHLY

Ministerial marriage coaching methods combine solution-focused therapy with Biblical principles. Positive approaches to problems are taken, believing that people are resilient and have the resources to address life circumstances. It is the role of the ministerial marriage coach to help married couples understand the dynamics of their situation and the power of God in their lives and to assist them in using their particular strengths to address these issues.

 

NATURE OF COACHING

ReConnect Marriage Ministries ministerial marriage mediators are not licensed, professional counselors. We provide only “ministerial”  marriage coaching services. Neither Do the Mediators represent Licensed councilors in Michigan.

 

GOALS, RISKS, AND BENEFITS

There is always a risk of ministerial marriage coaching’s emotional and other side effects. Symptoms may worsen before they get better. The goal is to confront issues and emotions together and work through them over time to benefit the marriage.

 

RIGHT TO PRIVACY/CONFIDENTIALITY

All communication between the couple and the ministerial marriage coach becomes part of ReConnect Marriage Ministries Marriage’s coaching records. Records are the property of ReConnect Marriage Ministries and will be stored and disposed of in accordance with Reconnect Marriage practices.

While most communication between an individual or a married couple and the ministerial marriage coach is confidential, the following limitations and exceptions do exist:

• ReConnect Marriage Ministries ministerial coach determines that a person is a danger to himself/herself or someone else.

• A person discloses abuse, neglect, or exploitation of a child, elderly, or disabled person.
• A person authorizes, in writing, ReConnect Marriage Ministries, to release records.
• ReConnect  Marriage Ministries is ordered by a court to disclose information.
• ReConnect Marriage Ministries is otherwise required by law to disclose information.

In ministerial marriage coaching, confidentiality belongs primarily to the relationship and not solely to the individual.

 

EMERGENCIES

You should contact your primary physician, a local emergency room, or the local police department when necessary and appropriate. The individual’s responsibility is to seek the appropriate resources in emergency situations.

 

ARBITRATION

Any claim or dispute arising from or related to this Acknowledgment, Authorization, and Consent Agreement (“Agreement”), other than a claim for injunctive relief, shall be settled by mediation or arbitration in  Michigan, in accordance with the then governing Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation. In the event that the Institute for Christian Conciliation ceases to exist during the course of this Agreement, arbitration under this section shall be conducted according to the rules of the American Arbitration Association. Judgment upon an arbitration award may be entered in any court otherwise having jurisdiction. The parties each agree to bear their own costs related to any mediation or arbitration proceeding.

By your agreement below, you indicate that you have read, understood, and approved this Agreement, and any questions about this Agreement were answered to your satisfaction. You also indicate that you have received a copy of this Agreement for your records.

 

Content provided by XO Marriage

Consent *

Please acknowledge that you have read and agree with the Ministerial Marriage Coaching Acknowledgment, Authorization, and Consent Agreement.

Name *

Phone *

Email Address *

Date of Birth *

Occupation *

What is your address? *

How many years have you been married? *

Are you currently living together? *

Are there any children living at home? *

If so, how many? *

Please identify the areas of struggle in your marriage (communication, trust, intimacy, finances, priorities, etc.): *

Which ONE area would you like to focus on during your 90-minute session? *

In your own words, please describe what happens when you attempt to resolve this area of struggle (negative thinking, escalation, withdrawing, dishonoring, etc.): *

How does God/faith play a role in your marriage? *

What are your goals/hopes in participating in this session? *

Spouse Section

Spouses Name *

Spouses Email Address *

Spouses Phone *

Spouse's Date of Birth *

Consent *

A 90-minute virtual session can be canceled or rescheduled up to 24 hours before the scheduled appointment.

If you cancel in less than 24 hours, it’s non-refundable. 

If you do not show up for your virtual session or the time that passes is greater than 15 minutes of the scheduled session, it’s considered a no-show and is nonrefundable.

Be advised that virtual sessions that do not start at the scheduled time will still end at the scheduled time.

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