Confidentiality &
Release of Information Form
Directions:
Fill out all sections of this form. Click submit when completed. A copy of the contents will be sent to the coach as well as to your provided e-mail.
All fields in this form are compulsory.
Basic details:
Agreement and Confirmation
I, as the client, attest I have read, understood and checked the items on this list myself. I attest that if I had any questions about the items in the lists above, I would have discussed them with Jennifer Kumar before I signed this form.
By filling out this form and submitting it digitally, it acts as an agreement between you and I that we will work together to the best of our abilities to achieve your goals.

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