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KGC Foundation Client Onboarding Form

PURPOSE:

This form helps us understand you, your needs, and how best to support you. All information is treated with care and confidentiality

First Name: *

Last Name: *

Preferred Name: *

Date of Birth: *

Gender *

Female Male Prefer not to say

Phone *

Email: *

Emergency Contact Name and Phone number: *

Which service are you seeking? (Select) *

Briefly describe what led you to reach out at this time:

Have you previously received support or counselling?(Checkboxes)

yes no

If yes, please share anything you feel is relevant . Are there any recent life events we should be aware of? ( For example loss, separation, conflict, stress, transition)

Preferred type of session (Select) *

Do you require any accessibility accommodations?(Checkboxes) *

Yes No

If yes, please specify

On a scale of 1-10, how are you feeling emotionally today? *

Are you currently feeling safe? *

Yes No

If no, please explain briefly

KGC Foundation is faith-led, but support is offered with respect and sensitivity.

Would you like faith or prayer to be included in your sessions? *

Yes No Not sure- lets see how it goes.

Are there any beliefs or values you would like us to be mindful of? *

What would you like to gain from engaging with KGC Foundation? *

What would a successful outcome look like for you? *

KGC Foundation operates on a donation or agreed service contribution basis. Payment details will be confirmed before your session.

Is tis a paid session or Donation based support? *

Paid session Donation Unsure

Agreed session fee or donation amount (if applicable)

Preferred Payment Method *

Bank Transfer Online Payment Link Other (please specify)

Has Payment already been made? *

Yes No

If yes, please provide the payment reference

I confirm that the information provided is accurate to the best of my knowledge.
I understand that KGC Foundation does not replace emergency or crisis services.
I consent to my information being stored securely for the purpose of support and service delivery.

Your full initials here: *

Date & Time completed: *

Thank you for trusting KGC Foundation. Someone from our team will be in touch shortly.

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