Update Staff InformationIf you want to update the information on your online biography or adjust a) who you work with (client demographics), or b) topics you work withDo you want Your Name * First Name Last Name Your Client's 1st Name & Last Initial (ex: John S.) * 1. Is this referral based on a client request or your recommendation? * (This form may use the words referral & recommendation interchangeably.) My recommendation Client request 2. Are you currently listed as the client's Primary Minister in Simple Practice (SP)? * To check, go to the client's profile in SP. Click "Edit" (next to their name) & scroll down to "Primary Clinician." We recommend a client having access to 1 minister (rarely 2 and very rarely 3). If you are not the Primary Minister & feel the client needs a referral, please contact the Primary to initiate the referral/make a plan for their client. If you are a Secondary Minister and continue this form, we will send it back to you & ask you to contact the Primary. Yes No, but I should be No, I'm listed as the secondary minister, and this is correct (STOP HERE - don't complete this form) 3. Are any other ministers currently listed on the account? * No Yes 4. a) If another minister is listed, who is it? b) Should they continue having access? c) Why or why not? * Write N/A if not applicable. 5. What service type is being requested? * * Indicates a lower price for Bethel students who've released their RGP/Mentor Sozo (Ari, Berta, Chrystal, Chuck, Cyndi, Debbie, Deborah, Edie, EJ, Faith, Gail, Gill, Hayde, Klaus, Laura, Lori, Nancy, Scott, Sebron, Selin, Stephen, Sue) Counseling (Clinicial: Al, Amaryah, Amy, Brenae, Dara, Jennifer B., John, Klaus, Leslie, Lori, Melissa, Suzanne, Wendy, Yvonne; Pastoral: Berta, Chrystal, Chuck, Cyndi, Debbie, Deborah, Faith, Laura, Lori, Nancy, Scott, Sebron, Yvonne) Coaching (Amber, Christina, Colleen, David, Faith, Jen F., Sara) Pre-Maritial Counseling (Sebron) Couples Counseling (Al, Amaryah, Berta, Brenae, Chrystal, Chuck, Cyndi, Dara, Debbie, Deborah, Jennifer, John, Klaus, Laura, Leslie, Nancy, Stacey, Suzanne, Yvonne) Brain Sozo (EJ) Body Sozo (EJ, Hayde, Chrystal, Nancy) *Limbic Release Sozo (Nancy) Boundaries Sozo (Deborah) Creativity Sozo (Faith) Sleep Sozo (Faith) - not for trauma related sleep issues Military Debrief (Scott) Missionary Debrief (Scott) *Financial Sozo *$175 (Stephen, Deborah, Lori, Nancy) *Financial Sozo for Couples *$200 (Stephen, Deborah, Nancy) *EMDR - *$175 (Dara) *Art Sozo *$150 + Supplies Needed (Gail, Gill) Addiction/Trauma Program Consulation $30/30 Min (Yvonne) - extra paperwork needed 6. What's the plan for this client? * (Once you see that we've emailed the client with access to a new minister, please contact the client to let them know the plan for their referral.) I'm handing them off to a new minister. For the foreseeable future, I'd like the client to be able to book with both me and the new minister. I'm sending them to have 1-2 sessions with the new minister and then I'll have the client check in with me. 7. Are you open to meeting with the client again in the future if needed? * N/A - I'm still working with the client, in tandem with another minister Yes - if the client/new minister thinks it would be helpful, I'm willing to work with this client again. No - I don't think I and/or my services are a good fit for this client. (If you select this option, please provide more details in the last question of this form.) 8. Is this referral/next appointment urgent? * No. They are fine to wait for the right person/a specific service type. Yes. This client has expressed they feel they are in crisis. (Note: If you select a service type that does not have availability soon, we will contact you to discuss options.) Yes. My client and I agree that they need to get in with someone (else) ASAP. 9. Are you aware of the client's general availability? * Days/times that work best for them - if so, please describe so we can find a good fit. 10. So that we can double-check or redo this referral (if needed), what skills/personality traits do you think are important for this client? * Someone gentle Someone with a strong personality who can take charge Someone who can help with intense spiritual oppression/blocks Someone who can give practical tools Someone who can diagnose mental illness Someone who carries joy/hope & can help with anxiety/depression Someone who can do both sozo and counseling Someone who can help with addictive behaviors Other (please describe below) Other important skills/traits I'm requesting (if applicable): 11. Please select the top priorities for this client: * Someone who's available in person Someone who's available as soon as possible The specific minister I selected The specific service type I selected The skills/traits I selected in question #10 12. Which minister(s) do you think would be a good fit for your client? * More info about each minister can be found in our TC Admin google spreadsheet. Select the Sozo, counseling, or coaching tab. Amaryah Reedy (CA clients only) Amber Kennedy Ari Isaoglu Berta Johnson Christina McCulley Chrystal Rodriguez Chuck Enomoto Cyndi Barber Dara Fields (CA clients only) Debbie Roberts Deborah Enomoto Edie Wilson EJ Benjamin Faith Blatchford Gill Kingsley Hayde Bulbuk Jen Fish Jennifer Brehme John Mathews (CA clients only) Klaus Roed Laura Burwick Leslie Taylor Nancy Young Scott Smith Sebron Tucker Selin Isaoglu Stephen De Silva Sue Elliott Lori Yuan Suzanne Luis Yvonne Martinez (only with prior approval from Yvonne OR for SBS consultation) I'm not sure if anyone at the TC is right for this client, and I'll describe why below. Melissa Helbach (CA clients only) 13. If you think this person might need someone outside the TC, please share why so we can best direct them. (Or N/A) * 14. What do you think would make the person/people you selected above a good fit for your client? * Please be specific in case they aren't available and we have to find someone else (we'll look for these attributes). 15. When we choose a minister, how do you want to be included in that decision? * Please send me an FYI of which minister is chosen. I'd like to be more involved. Please let me approve whichever minister you're recommending before offering them to the client. 16. Is there anything else you think is important for us to consider/know for this referral? * Thank you!
