Appointments

Setup appointment

In order to make an appointment for mentoring or life coaching please fill out the form below

Thank you for your interest
Please read the agreement and answer questions to the best of your ability. A few notes we want to make sure you understand about the ministry:

1. We provide healing prayer in our mentoring sessions
2. The suggested donation amount is $90 per session to cover a portion of our operating expenses. Do not let lack of funds deter you.
3. We are a non-profit, all donations are tax deductible

* Indicates required field

Name *

Phone Number *

Email *

Preferred approach for sessions *

In Person Skype/Zoom Phone

Who would you like to make contact with? *

Please list all days of the week and times of day you are available for sessions *

Who referred you to us? *

Pathway to Hope does not require mentoring staff to be licensed professionals. All Pathway to Hope staff mentors have received lay counseling, coaching or mentorship certifications and training. They may also have varying levels of additional training. Your mentor is not always immediately available by phone. If you ever have an emergency, it is best to dial 911.

Do you understand that Pathway to Hope is not a licensed counseling organization, and does not accept insurance? *

yes no

Pathway to Hope operates on a donation basis for individual mentoring sessions. Mentoring sessions are up to 90 minute sessions.

Do you understand this policy? *

yes no

The communication between you and Pathway to Hope staff is considered confidential. Your records will not be released outside of Pathway to Hope without your written consent. Exceptions to this confidentiality can result from one or more of the following circumstances: (1) When you say or do something that threatens your safety and/or suicide; (2) When you say or do something that threatens the safety of others and/or homicide; (3) When there is a known or suspected child abuse; (4) When records are court ordered by a judge compelling disclosure.

Do you understand this policy? *

yes no

My typed name below indicates that I have read and answered the above questions to the best of my knowledge and ability, and am not signing this document under any duress.

I acknowledge the limitations inherent in ensuring confidentiality of information transmitted through online mentoring. I agree to waive the privilege of confidentiality with respect to any confidential information transmitted through online mentoring that may be accessed by any third party without my authorization and despite the reasonable efforts by the Pathway to Hope staff to arrange a secure online environment.

I understand that all prayer and mentoring practices are not guaranteed to provide relief, no promises intended, and I do not hold the Pathway to Hope staff liable in any way.

PLEASE TYPE YOUR NAME AS INDICATION THAT YOU AGREE AND APPROVE OF THESE STATEMENTS.

Name *

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