11. May Ashley acknowledge the referral?
15. What best describes why you are interested in a private session? (Please check all that apply.)
17. Have you ever been treated for depression/ anxiety?
18. Are you or have you been in the care of a therapist or psychiatrist?
20. May Ashley have permission to contact this person?
21. Do you or have you had suicidal ideations?
22. Do you or have you had homocidal ideations?
For Astrological Consultations Only
26. Birth date (If you prefer not to enter your birth information online, you may call Ashley with your birth date, place and time instead.) 24. Have you ever had your natal chart read before?
27. Birth time (An accurate birth time will greatly enhance the amount of information available during the reading. If you are unsure of your correct birth time, please check your birth certificate or contact your birth hospital or city.) It is the policy of Ride the Wave Yoga LLC to protect the privacy of the information shared during private sessions to the maximum extent possible. Generally, information about you or services provided to you will not be released without your prior verbal consent. There are, however, some circumstances which require the disclosure of information without your consent, such as when:
a.) mandated by state or federal law due to suspicion or knowledge of child abuse and/or neglect or elder abuse and/or neglect,
b) there is an imminent risk or serious threat of physical harm to self or to others, and
c) specifically ordered by a court of law.
29. I agree to the Terms of Confidentiality. *
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