Client Information Form

Please complete this form before your first coaching session.

Last Updated: 12th August 2024

All information is treated confidentially and stored securely, in line with Clear Horizons’ Data & Privacy Notice.

If you have any questions while completing it, please email becky@clear-horizons.co.uk.

Personal Information

When you submit this form, it will not automatically collect your details, like name and email address, unless you provide them yourself.

First Name

Last Name

Preferred Pronouns

Date of Birth

Address

Address Line 1

Address Line 2

Town/City

County

Postcode

Phone/Mobile

Emergency Contact

Preferred Method of Contact

If Other, please tell us how you would like to be contacted

Best time to contact you

Reflection Questions

Please take some time to reflect on the following questions. There are no right or wrong answers - just your honest thoughts and feelings. You can write as much or as little as feels right for you.

What brings you to coaching at this time in your life?

What do you hope to explore or discover through our coaching sessions?

Is there anything about how you think, feel, or make decisions that you'd like me to know as we begin?

Final Thoughts

Is there anything else you'd like to share with me before we begin our coaching sessions?

Signature

Sign Here

Date