Registration Form For Clients
Please complete and return
|Address for correspondence
Address you will be at during the call
|Date of birth||Occupation (optional)
|Emergency contact person
(name, phone number)
PLEASE SIGN HERE TO INDICATE PERMISSION FOR MIRIAM GRACE / BLUE SKIES TO HOLD THIS INFORMATION FOR THE DURATION OF YOUR TIME WORKING WITH HER ONLY. WHEN YOU LEAVE THESE CONTACT DETAILS WILL BE DELETED.
|GDPR COMPLIANT SIGNATURE
All client data is confidential and kept secure and protected. Personal information asked for here is kept in a separate from any therapeutic material and is password protected for use by Blue Skies only. We will use this information for contacting you if necessary. In an emergency e.g. a client is taken ill during a session or the therapist is unable to attend and unable to cancel the session, this information (only) would be accessible to the therapist’s clinical supervisor and/or emergency medical professionals.