Registration  Form  For  Clients

to be completed at the first session or prior to arrival if you prefer


Personal information  
Mobile phone Alternative phone (optional)
Date of birth (optional) Email (optional)
GP Name Occupation (optional)
Surgery Surgery phone
Medical conditions Medication
Emergency contact person Their phone number



All client notes and data are confidential. Process notes (about your therapy sessions) are kept separate from your personal information, and kept secure and protected. Personal information asked for here is kept in a separate locked cabinet and also on computer for use by Blue Skies only. We will use this information for contacting you if necessary and once therapy has ended should you request to be on our mailing list.  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, then this information (only) would be accessible to the therapist’s clinical supervisor and/or emergency medical professionals.


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