Referral Consultation

Jasmine Jarchevska, BA (Hons), Dip. Psych., UKCP Accred. (https://nursethesoul.com/about/) offers referrals to other therapists, healers, nutritionists, shamans, psychiatrists, psychologists, astrologers, schools, retreats and rehab clinics through her Nurse The Soul referral network.

You may find yourself on this page because you have asked Jasmine for a referral for either yourself or for a partner, family member, a best friend or because you’re looking for a specific speciality. Or, perhaps you were sent this link by someone you know to organise a referral consultation.

a referral starts with you filling out the form based assessment below and then booking in a referral consultation with Jasmine. This is a 50 minute appointment in which you will talk more with Jasmine. She will go through some of what stands out in your form with you in more detail, endeavour to understand more about your journey, get to the crux of what you’re looking for and see what is the undercurrent that brought you to this moment in time. It is also an opportunity for Jasmine to experience the way your energy moves and the way you naturally connect so she can match you with someone that matches your energy.

After the consultation Jasmine will then spend time going through an intuitive process which includes personality profiling, meditation, reflection and also practically going through her contacts so that she can match you with the right referral and with someone that is available for you to work with.

The whole process takes Jasmine about 3 hours and the cost of a Referral is £350 (https://nursethesoul.com/fees/). Within a week after the assessment you will be confidently matched with exactly the right therapist, healer, school, retreat, clinic or centre for you.

If you are new to Nurse The Soul and are wanting a referral for yourself please begin by filling out the form below. Once Jasmine has received your form she will send you times to book in your referral consultation and payment details.

If you have already worked with Jasmine whether it be one to one or in circles, please fill out as much new details as possible below and As soon as she receives your form she will contact you to book in your referral consultation.

everything you write is strictly confidential. When you press send at the end of filling out the form Jasmine will receive it straight to her email inbox.

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Name

Age

Telephone number

Email address

Date of birth

Place of birth

Nationality

First language

Gender

Location

Presenting issue(s) (Why have you looking for a referral, brief history of issue(s), symptoms, general mood, emotions).

Current and previous therapy (Who, why, when, how long, why did it finish, outcome).

Medical history (Medical conditions, disabilities, learning difficulties, current medical issues, current supplements and medications – specify dosages and how long you have been taking them for, psychiatric history, hospitalisations, surgical trauma issues, major accidents, plastic surgery, abortions, miscarriages, allergies, other).

Substance use (History, when started, type, quantity, drug of choice, alcohol, tobacco, drugs, other, treatment programs – where, when, whether completed, how you experienced it).

Abuse (History, experience of neglect, emotional abuse, physical abuse, sexual abuse – have you ever been the recipient inside or outside of the family of unwanted inappropriate sexual acts).

Suicide (Ideation, attempt, when, under what circumstance).

General health (Physical health, energy levels, sleep and duration, diet, nutrition, what is your eating like, what do you eat in a day, exercise, past/ present eating related issues, feelings around body/ weight/ skin, any cosmetic procedures, when period started and how is your menstruation cycle now if applicable).

Early life (Mother’s pregnancy, birth, breastfed, childhood traumas, childhood illnesses, separations, abandonment, what family life was like, how parents and siblings were experienced, what were your favourite toys, did you have an imaginary friend, memories of being at school, early childhood friends, other important relationships ie nannies, teachers, who was there for you growing up).

Childhood dream(s) (What were your childhood dreams).

Mother (Name, age, occupation, where living, marital status, how you experience her, dynamics of your relationship with her, dynamics of her relationship with your father, dynamics with you as a child, dynamics with your siblings/ partner/ children if appropriate, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, spiritual beliefs, if passed when did this happen and under what circumstance).

Father (Name, age, occupation, where living, marital status, how you experience him, dynamics of your relationship with him, dynamics of his relationship with your mother, dynamics with you as a child, dynamics with your siblings/ partner/ children if appropriate, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, spiritual beliefs, if passed when did this happen and under what circumstance).

Step Mother/ Step Father [if applicable] (Name, age, occupation, where living, marital status, how you experience her/ him, dynamics of your relationship with her/ him, dynamics of their relationship with your mother/ father, dynamics with you as a child if appropriate, dynamics with your siblings/ partner/ children if appropriate, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, spiritual beliefs, if passed when did this happen and under what circumstance).

Siblings [if applicable, begin with the eldest] (Name, age, occupation, where living, marital status, how you experience her/ him, dynamics of your relationship with her/ him, dynamics of their relationship with your mother/ father, dynamics with you as a child if appropriate, dynamics with your other siblings/ partner/ children if appropriate, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, spiritual beliefs, if passed when did this happen and under what circumstance).

Children [if applicable, begin with the eldest, note some of these questions are only appropriate for adult children] (Name, age, occupation, where living, marital status, how you experience her/ him, dynamics of your relationship with her/ him, dynamics of their relationship with their other parent, dynamics of their relationships with their grandparents, dynamics with their other siblings/ partner/ children if appropriate, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, spiritual beliefs, if passed when did this happen and under what circumstance).

Other significant family members [if applicable, e.g. grandparents, other relatives] (Name, age, occupation, where living, marital status, how you experience her/ him, relationship dynamics with you and others in the family, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, spiritual beliefs, if passed when did this happen and under what circumstance).

Brief family health history if not previously mentioned (Please include maternal and paternal grandparents health and if they passed because of an illness please write what kind).

Current relationship(s) [if applicable] (Name, age, occupation, where living, marital status, how you experience her/ him, dynamics of relationship, children if appropriate, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, what’s the day to day like in this relationship?).

Most important previous relationship(s) [if applicable] (Name, age, occupation, where living, marital status, how you experience her/ him, dynamics of relationship, children if appropriate, substance use, mental health issues, emotional health issues, physical health issues, brief medical history that you know of, reason ended).

Pet(s) [present or past important pets] (Name, age, personality, relationship).

Education (State, private, boarding, religious, international, Steiner, Waldorf, Montessori, a levels subjects, higher education, which university, post grad qualification, current studies and courses, names of qualifications, how you experience(d) your education, thoughts on education, how you feel about learning and studying, what was a personal choice and what was influenced by parents and/ or what others were doing).

Occupation and work history (Past and present, what kind of work, how do you feel about it).

Inner work history (Is there anything you want to share that you haven’t previously mentioned on any inner work you’ve experienced or are interested in? For example, Transpersonal and Jungian psychology, retreats, shamanic work, astrology, shadow work, EMDR, family constellations, body work, deep interest in ‘X’ which you read/ listen to podcasts on/ watch YouTubes on/ go to seminars on/ go to conferences on/ go to meet ups on, dream work, art therapy, music therapy, dance therapy, myth, tarot, naturopathy, inner child work, breath-work, meditation, plant medicine, workshops, circles, spiritual groups you’re a part of, yoga, rituals, sponsor relationship etc).

Spirituality (Religion, beliefs, family, religious pressures by family, spiritual practices, what do you believe in).

Sexuality and gender (Are you currently struggling with any sexual or gender related issues e.g. intimacy issues, yours or your partner’s loss of sex drive, painful sex, bdsm, fetishes, sex addiction, sexual orientation, transitioning, are you happy with your sexuality, are you happy with your gender).

Social relationships (How many friends do you have, are they close, how do you experience the quality of your friendships).

Protective factor (What gives you strength, what keeps you going).

Goals, hopes and dreams.

Any other significant factors (Cultural issues, ethnic issues, travel, finances).

Are you currently involved in any legal issues?

Am I connected with any of your friends or family?

Is there anything that hasn’t been mentioned that you feel is important?

Day and times for a referral consultation with me?

In what time frame would you like to begin your session(s) with the person/ clinic I refer you to?

Do you have any commitments that mean you would only want sessions in the day time/ evening or weekends?

Would you like in person sessions, Zoom, telephone, or do you not mind?

I’ve asked you so many questions, is there anything you want to ask me?

By returning this form, you accept that under the General Data Protection Regulations Jasmine can process and retain your personal data for the purpose of referral.

It shouldn’t take Jasmine longer than 48 hours to send you a email saying that she has received your form. If you haven’t received a message from her please check in with her and ask if she has received it via email jasmine@nursethesoul.com or message +447545913193.