Client Information Form

We’d be so grateful if you could complete a Client Information Form before your first session so that we can support you in ways that will serve you the most.

You can print this form HERE and complete it by hand and bring it with you, or you can complete the form securely online HERE anytime before your session.

Please also either contact us to put a credit card on file or print and complete the Credit Card Authorization Form (optional) to allow easy payment of session charges. Be assured that all forms and answers are held in utmost confidentiality and compassion. Thanks so much!

All clients can find our Notice of Privacy Practices here (does not need to be printed)

Also, this form works for any and all individual sessions — whether you scheduled through Joy Potential ( or through our Center for Thriving Relationships (

Thanks so much for sharing, and we truly look forward to connecting soon!

We fully understand that unexpected things may come up. Please know we do require at least a 24-hour notice if you need to cancel or reschedule so that we can make that time slot available to another client. If you use our online calendar above, automated appointment reminders are sent to you 36 hours and, again, 6 hours prior to your appointment. If you need to cancel or reschedule less than 24 hours before your appointment, you will be charged $35 per scheduled hour. If you miss an appointment without contacting us at least 6 hours beforehand, you will be charged the full session fee. This is simply because your scheduled time slot was not available to be filled by another client, and preparations and considerations were made based on your session. Thanks so much for your understanding and honoring of this. Also, please note that insurance cannot be charged for these fees.


(via Hwy 37, coming from the North or South)

* Take Fullerton Pike exit off of Hwy 37 (where Monroe Hospital is).
* Head West on Fullerton Pike (RIGHT if coming from the North or LEFT, after the traffic circle, if coming from the South).
* At the stop sign, turn left on S Leonard Springs Rd.
* After about a quarter mile, we will be on the left. Our house is brick and our driveway is just on the other side of the brown wood fence with the tall evergreens (4307 S Leonard Springs Rd). Please park in an empty spot in the parking area along the right side of the driveway.
* At the end of the driveway is an arbor arch. Please go through the arbor arch, down the stone path, and across the bridge. Ahead you will see double glass doors which open to our waiting room. Please come right in and someone will be with you shortly.

Driveway approach
Eartheart Institute
Arch Entry