Sleep Health Intake

This questionnaire is to help us at The Art of Rest understand a bit about who you are, where you're coming from, and what direction you'd like to head towards. What follows are questions that help me understand where you currently are in your process as well as provides important information for you to know about the nature of my guidance work so that we are both able to move forward with clarity and confidence in our time together.

If you have questions or concerns in filling this out, please feel free to email me at dagnyrose@theartofrest.me.

Please review the following agreements and virtually sign and date at the bottom. 

Service Description: This is an agreement between Dagny Deutchman of The Art of Rest and the agreeing client to work for online or in-person sessions for coaching sessions for one hour each, unless prior arrangements are otherwise discussed. These meetings will be guided and informed by the client's intentions and goals and will be re-calibrated as necessary

Guide Commitments and Responsibilities: I, Dagny Deutchman, agree to support my clients to the best of my ability, knowledge, and experience. It is my value to do that within my scope of practice and refer or recommend when possible to higher or different levels of care. I will support you in creating your own roadmap towards your desired relationship to your sleep-heath, dream life, nervous system and stress management—depending on the nature of our agreed upon work together. Each meeting I will provide support, reflection, and guidance, while also providing resources, prompts, practices, reading recommendations, and ideas for you to engage with during the time between sessions. 

Client Responsibilities: This work is most effective and meaningful when clients are committed to consistently engaging with practices, routines, rituals outside of our meeting times. When working remotely, much of our work together relies on you developing an intimacy with  and accountability to your own practices and intentions. If you are struggling to make this work, it is the client's responsibility to request additional support between sessions for an additional fee agreement. It is also your responsibility to arrive on-time to your sessions, as sessions will not be extended due to late arrival.

Communication: You are welcome to email me at dagnyrose@theartofrest.me anytime in between sessions with thoughts, questions, etc. and I will do my best to respond promptly. If you email me over the weekend, please understand that I may not return communication until the following Monday. There will be times that I am unavailable for longer periods  while guiding in remote locations. When these occur, I will provide you with advanced notice and resources for while I am away. For extra support beyond email communication, please inquire about additional services. If extra communication, accountability, and support is requested, a separate contract will be co-created to suit both parties needs.

Nature of services disclosure: Client acknowledges that guiding does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association and that guiding is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals and that it is your exclusive responsibility to seek such independent professional guidance as needed. If you are currently under the care of a mental health professional, it is recommended that you promptly inform the mental health care provider of the nature and extent of our guiding  relationship. By signing this document, you agree to this disclosure and terms.

Confidentiality: I keep all the information you disclose, as well as our guiding relationship itself, strictly confidential, unless by your written permission.

Cancellation: All appointments require a minimum of 24 hours notice for rescheduling or cancellation. Monday appointments require notice by Friday. The full fee will be charged for missed sessions without prior notification. An exception will be made in the case of an emergency.

Discontinuing Services: Both the guide and client may terminate services at any time for any reason. If you do plan to discontinue services, please provide advanced notice, if possible. If the client discontinues services before using all of the sessions that have been purchased, those sessions will remain available to them for up to 6 months. After that time, they will be forfeited. A refund will not be issued.

Reciprocity: Here at The Art of Rest we acknowledge the harmful limitations certain financial capacities and we also recognize the realities of needing to function within that system for the time being. Our goal is to provide resources as accessibly as we can with the long-term goal of moving towards equity in sharing resources.

To that end—please pay what you are able to afford within the sliding scale so that those located in different financial circumstances than you can have access to the same material. Your payment amount does not impact the quality of services or time that you receive. All clients will receive equal services regardless of financial contribution.

All parties herein consent to the above agreement and are providing a digital signature and date of signature to indicate their agreement and willingness to comply with the above statements. If you are the guardian of a minor, I please check "other" and indicate that you are the guardian consenting to the working terms for the minor involved.

If you would like to pay for our first session now, please feel free to do so. If you choose not to pay for our first session at this time, please reach out to touch base about payment or we will use some of the time in our first session to cover fees.

Sliding Scale Fee:

$55 - $150 / hour

*$85 and above is my preferred price point

Please pay what you are able to afford so that I can continue to serve peoples from all financial backgrounds