Intake Form

After you have filled out the form in the specific group page please fill out this intake form. If you have not filled out the form on the group page please do so first then come back. Please use the same first and the last name on both forms.

Do you, your partner or anyone in your home have any of the following challenges:

If you answered yes to any of these concerns, and you believe that your challenge in these areas is minor, then:

  • We suggest you discuss the issue with the Harts during the initial free call. There are some situations when we give individuals permission to attend if certain conditions are followed.
  • Please explain briefly here:

If you answered yes and you know your problem is serious, please understand that we have great compassion for what you are going through and we wish we could support every individual and/or couple who wants help, but there are limits to what we can do in a spiritual mentoring program. If you or your current partner or a child/ teenager/adult (related or not related) living in your home are struggling with these kinds of issues our mentoring groups and even our private sessions can not offer you the quality of support that you need. We suggest you reach out to a psychologist or psychiatrist or a lawyer.

We will dismiss individuals and couples from the program who are not upfront about these issues. Remember we do not offer refunds.


The next two questions apply only to the autism group:

* means required field