My name is Elizabeth Bowman. I am the founder and principle operator of Unlockinghearts, LLC. I have had the privilege to mentor, disciple, counsel and journey alongside many women from a wide range of backgrounds, including those who have suffered through abortion, substance abuse, and various other forms of physical and emotional trauma. I come along side individuals to help them identify and live out the truth of their identity in Christ Jesus. I offer discipleship counseling which is gospel centered, coming alongside you as an individual with words of truth to encourage, teach, comfort and asssit you during your time of need. The primarily focus is on changing the heart through having a greater undersanding of what Christ has done for you-which leads to change in behaviors. Please undersatnd that I am not a licensed professional counselor.

Romans 12:2 "Do not be conformed to this world, but be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is acceptable and perfect."

CLIENT AGREEMENT

Thank you for your interest in working with me as a client. Please read this information carefully and ask

any questions you may have before signing this agreement.

Phone calls ( 704-604-9363): Calls are returned Monday through Friday, all calls will be returned within 1 business day.

Please leave your phone number and first name with your message.

Emergencies: If you have an emergency please call 911 or go to your nearest Hospital Emergency Room.

If you feel I need to be made aware of the situation please call me after seeking appropriate emergency care.

Cancellation policy: Unlockinghearts has a 24 hour cancellation policy. If you fail to cancel a scheduled appointment, I cannot use this time for another client. Please be aware any outstanding cancellation fees must be paid before scheduling another appointment.

Therefore, you will be billed for the entire cost of a missed appointment.

Please complete this form with as much detail as you can and submit prior to your session. Your information is important to me and will be held in the upmost confidence. 

Where may I contact you ( check all that apply)

Emergency Contact Person: 

Emergency Contact's Cell phone:

Current martials status:

Are you currently employed?

Have you ever attempted suicide? If yes, please explain WHEN and HOW:

Do you currently have thoughts of suicide? ________

 How you ever attempted suicide? If so, how many times 

Do you have a plan? ________If yes, please explain your plan below:

Have you ever had an abortion? If yes, please explain when, how old and how many:

Please list four goals that you would like to set from working with Unlockinghearts.

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2.

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4.

Finally, please take moment to describe what your expecting from Unlockinghearts?

I have reviewed this Informed Consent Agreement. I likewise understand my Client's Rights set in this form.

I accept this agreement and consent to counseling.

By signing this Client Information and Confidentiality, Disclosure, and Consent Form, I acknowledge that I have read, understand, and agree to the terms and conditions contained in this form. I have been given appropriate opportunity to address any questions or request clarification for anything that is unclear to me. I am voluntarily agreeing to receive services for me, and I understand that I may stop such services at any time.

Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Elizabeth Bowman and Unlockinghearts, LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s)