Ice-Breaker: Noun

A ship designed for breaking a channel through ice; a thing that serves to relieve inhibitions or tension between people

Print the Hoarding Ice-Breaker Form (for FREE), fill it in and use it to start a conversation with your doctor/GP, clinician or other trusted person/professional, so you can get practical advice, support and medical treatment to help make you feel better


  1. Click on the button or image for your chosen language (the form should appear on your screen automatically)
  2. Print the form (you don’t need to download it)
  3. Tick all the boxes that apply, and write down additional information as appropriate
  4. Follow the guidance on how to prepare for your conversation with the trusted person, what to expect (questions that might be asked, etc) and what to do afterwards

The form asks questions related to the types of problems many people experience, and briefly outlines factors that may have contributed to the person becoming unwell or needing to reach out for help and support.

Why might someone use the Hoarding Ice-Breaker Form?

Many people feel too embarrassed or stigmatised to talk about how unwell they feel because of issues related to clutter, disorganisation or hoarding behaviours, or how much it’s adversely affecting their lives.

If they have have nobody to talk to who they feel they can trust, it can become such a problem that homes become dysfunctional (eg. without heating or hot water, limited/no access to a toilet, etc) or unsafe to themselves and others (eg. others living in the property or neighbours) due to fire risks; slip, trip or fall hazards; mould or infestations (eg. mice, bed bugs, etc).

They may have so many possessions that they rent off-site storage units; store items in gardens, sheds, etc, or end up sleeping in their car. It can tear families apart, and if people become so unwell they are admitted to hospital, it may not be possible to discharge them because their home is too unsafe for them to return to; this can lead to other patients having to wait for beds to become available (known as “bed-blocking”).

Instructions – Print & tick

1 – Click on the button or image for your chosen language

2 – Print the form (you don’t need to download it)

3 – Tick all the boxes that apply, and write down answers to the questions (as appropriate)

Well done, you’re almost there……

Now click HERE for guidance on how to prepare to discuss what you’ve written, the type of questions you may be asked (with sample answers), and what you should consider doing afterwards


We are extremely grateful to the following people who very kindly volunteered to translate the Hoarding Ice-Breaker Form from English into other languages:

DUTCH Hilde HW Verdijk* of Yourganize in The Netherlands

POLISHJoanna Ladocha** of Go Win At Life in the UK

SPANISH – Nacho Eguiarte* of Nach Organiza in Mexico

*Hilde and Nacho are Members of the Institute for Challenging Disorganization

**Joanna is a Member of The Association of Professional Declutterers & Organisers (APDO)

We’d love to hear from you if you’d like to volunteer to translate the Ice-Breaker Form into another language.

We’d especially love to have it available in Braille!

search previous next tag category expand menu location phone mail time cart zoom edit close