For New Clients

Client Forms

Before we begin working together, please complete and sign the three forms below. They take only a few minutes, and everything you share is kept strictly confidential.

1. Coaching Consent Form 2. Brief Grief Questionnaire 3. Session Recording Consent

Form 1 of 3

Coaching Consent Form

Pet loss grief coaching is a supportive, educational service. It is not psychotherapy, counseling, or medical treatment, and it does not diagnose or treat any mental health condition. Kathleen Thera is a Certified Pet Loss Grief Coach, not a licensed mental health professional.

If indicators of complicated grief emerge during our work together, I will refer you to a licensed mental health professional — your wellbeing always comes first.

If you are in crisis, please call or text 988 (Suicide & Crisis Lifeline) immediately — support is free, confidential, and available 24/7.

Full Name *

Email Address *

Phone Number (Optional)

Please read and check each statement * I understand that pet loss grief coaching is not therapy, counseling, or medical treatment. I understand my coach may refer me to a licensed mental health professional if needed. I understand I can pause or stop coaching at any time. I consent to the privacy practices described on this site.

Signature

Full Name (acts as your electronic signature) *

Date *

By typing my name above and submitting this form, I agree that this serves as my electronic signature. *

* Required fields

Your information is kept strictly confidential and will never be shared.

Submitting your form...

Form Submitted!

Thank you — your consent form has been submitted. Next, please complete the grief questionnaire below.

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Form 2 of 3

Brief Grief Questionnaire

This short questionnaire helps me understand where you are in your grief journey, so our sessions can meet you exactly where you are. There are no right or wrong answers — and everything you share is confidential.

Full Name *

Email Address *

Your Pet's Name *

Type of Pet *

If Other, Please Specify (Optional)

Date or Approximate Time Since the Loss *

Your Relationship to Your Pet *

Please rate each statement from 1 to 5 *

1 = Not at all · 5 = Extremely

I think about my pet every day

1 2 3 4 5

I feel intense longing for my pet

1 2 3 4 5

I have difficulty accepting the loss

1 2 3 4 5

The grief interferes with my daily life (work, sleep, relationships)

1 2 3 4 5

I avoid reminders of my pet

1 2 3 4 5

I have thoughts of harming myself or not wanting to live

1 2 3 4 5

If this applies to you, please also call or text 988 (Suicide & Crisis Lifeline) — support is free and confidential, 24/7.

Is there anything else you'd like me to know? (Optional)

Signature

Full Name (acts as your electronic signature) *

Date *

I confirm the answers above are true to the best of my knowledge, and by typing my name above and submitting this form, I agree that this serves as my electronic signature. *

* Required fields

Your information is kept strictly confidential and will never be shared.

Submitting your form...

Form Submitted!

Thank you for sharing this with me — your questionnaire has been submitted. One last form below: the session recording consent.

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Form 3 of 3

Session Recording Consent

Coaching sessions may be recorded — only with your consent — so that you can rewatch them whenever you need, and to help me maintain the quality of our coaching work together.

Recordings are private: they are never shared with anyone without your written permission, they are stored securely, and they are deleted upon your request at any time.

Full Name *

Email Address *

Please choose one * I CONSENT to recording of my coaching sessions I DO NOT consent to recording of my coaching sessions

Signature

Full Name (acts as your electronic signature) *

Date *

By typing my name above and submitting this form, I agree that this serves as my electronic signature. *

* Required fields

Your information is kept strictly confidential and will never be shared.

Submitting your form...

Form Submitted!

Thank you — all three forms are complete. I look forward to meeting you.

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Please try again or email me directly at Bplgcoach@gmail.com

Questions about these forms? Email me at Bplgcoach@gmail.com