Getting Started

If you have any questions, concerns, or just want to talk to me before deciding whether you want to try out my approach, please contact me.  The most efficient way of getting started is to copy and paste the two forms I’ve provided below.  Fill out the intake form, and then you can email it to me, or you can mail it along with a signed Declaration of Rights form in the US mail (my mailing address is in the ‘contact me’ section).  I will need a signed hard copy of the Declaration of Rights form by the time I start our first session.  Once I receive and look over your intake form, I’ll then call you to either address any issues I might have with your situation, or to simply schedule you in so we can get started.  I’ll talk to you about ordering the first manual at that time if you haven’t ordered it already.

Contact me

Intake Form

I am asking for quite a bit of information with this intake form.  I’m doing so with the intent of getting your process moving in as efficient a way as possible, and if you don’t write about it here, I’ll be using session time to ask you about it, so please take the time to respond to all the questions below with as much depth and clarity as possible.  Please try to be as honest and concise as possible.  Don’t worry about giving your whole story here.  I’m just looking for a well-informed starting point that we can work from.  All information given is confidential.

1) What is your : First and last name, phone number and email address, age, height, weight, race, and relationship status.  

2) Explain what the problem(s) is that you want to work with.  Please try to speak to both the actual problem and the consequences that it generates.  For example, I have panic attacks (actual problem), and they keep me from being able to have a romantic partner in my life (consequence of the problem).  Please remember that your problems will have an internal, emotionally debilitated part and an on-the-ground part.  Please try to address both sides of this equation as you explain our problem(s).  I also want to know what you have done to try to help the situation and if anything has helped.

3) What do you want to accomplish from the work we will do together?  Please try to be as specific and as tangible as possible here.  ‘I want to heal’ or ‘I want to get better’ is too vague.  ‘I want to resolve my panic attacks,’ or, ‘I want to learn how to build into lifelong partnership’ are much more specific.  Note that every goal you state will need to be earned, so please don’t give me a Christmas list of things you want to be given.  I’m looking for what you’re willing to fight for, even if it feels impossible to achieve.

4) Write up to half a page on your life history, explaining:

  • where and how you grew up
  • your family situation
  • educational history
  • any major traumatic experiences—emotional, physical, or sexual abuse

 Focus on whatever seems relevant to your problems that you’ve presented above.

5) Write up to half a page on your life now, explaining:

  • your professional life
  • your personal life
  • your social life
  • what you do for fun
  • how you rest and recuperate

6) What is your definition of being financially independent?  From the time you started working (what age was this), how many years have you been financially independent?  Do you have a trust fund, inheritance, or any other type of money that was given to you, is waiting to be given to you, or is periodically given to you? 

7) In a paragraph, describe who you are.

8) What does it mean to be emotionally independent?  How do you take care of yourself emotionally?

9) On a scale of 0 (none) to 10 (a lot), how intensely do you experience the following emotions in your regular life:

  • Anger
  • Sadness
  • Fear
  • Shame
  • Worthlessness

10) Can you cry?  If yes, briefly explain how easy it is for you to cry—i.e. only when I’m watching a sad movie, whenever I want to, etc.

11) What religious tradition were you brought up with?  Do you have a connection to God, to Creation, or to anything greater than yourself in your life?

12) Explain the type and amount of experience you have had with the natural world.

13) How much time in a normal day do you spend on your phone?  How much time in a normal day do you spend on social media?

14) If I placed a bicycle in front of you with the necessary tools, and pointed out a part of the bicycle that’s not functioning correctly, how confident would you be to engage with the problem? (Rate your confidence from 0 to 10 where 0 is no confidence, 10 is fully confident.)  How excited/curious would you be to explore the problem? (Use the same 0 to 10 gauge.)

15) How many sexual partners have you had in the last 6 months?  How often are you having sex?

16) Have you or a partner had an abortion?  If yes, how many?

17) Do you:      drink alcohol- if yes, how often?

          smoke cigarettes?

          use any drugs, including prescription meds- if yes, what drugs?

          drink caffeinated beverages- if yes, how often?

18) In a short paragraph, describe your general diet?

19) Do you work out at a gym?  Do you have any physical injuries?  How is the health of your body?

20) Do you have access to a bathtub?

21) If there is anything else that you feel is relevant to mention, please do.

Declaration of Rights Form

 I, the undersigned, request that Doug Grand perform an evaluation and have sessions for the purpose of enhancing my health.  I understand that Doug Grand is an ordained minister with the Universal Life Church and that this therapy is not intended as diagnosis, prescription, or treatment of any disease, physical or mental.  I also understand that this therapy is not intended as a substitute for regular medical or psychiatric care.  I understand I’m not being advised by Doug Grand to discontinue any prescribed medication or medical or psychological care.

ARTICLE IX   US CONSTITUTION

“The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the People.”

Under the Ninth Amendment to the Constitution of the United States of America, I retain the right to freedom of choice in health care.  This includes the right to choose my diet, and to obtain, purchase, and use any therapy, regimen, modality, remedy, or product recommended by the therapist, doctor, or any practitioner of my choice.  The enumeration in this declaration of these rights shall not be construed to deny or disparage other rights retained by me, or my right to amend this declaration at any time.

CONSTRUCTIVE NOTICE

Notice is hereby given to any person who receives a copy of this declaration and who, acting under the color of law, intentionally interferes with the free exercise of the rights retained by me under the Ninth Amendment, as enumerated in this Declaration, that they may be in violation of my civil and constitutional rights, Title 42, U.S.C. 1983 et seq. and Title 18, section 241.

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Songs of Life LLC     ●      PO Box 194     ●     Rodeo, NM     ●     88056