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Client Intake Form for Individual Consultations

Please take the time to fill out the information below electronically.  All information is kept strictly confidential.

Basic Information

11. May Ashley acknowledge the referral?
15. What best describes why you are interested in a private session? (Please check all that apply.)

Health History

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

24. Have you ever had your natal chart read before?

Terms of Confidentiality

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. 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.

Thanks for submitting. Ashley will be in touch soon.

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