CONTRACT

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The purpose of this form is to share some important principles, which guide my therapeutic practice so that your decision to embark on therapy with me can be based on accurate, informed expectations. Please read this carefully and feel free to ask any questions about what you have read if you need further clarification.

THERAPY

Therapy is a process, which relies heavily on building a trusting relationship between therapist and client. This takes time in order for a person to open up and for the therapist to understand what he or she is struggling with. In order to do justice to the therapeutic alliance, one needs time to be in a process that is going to bring you long term change, therefore. If you are looking for short term work, then I may not be the right therapist for you,

CONFIDENTIALITY

In general, one of the most important rights the person seeking therapy has involves confidentiality.  Information revealed by a client during the sessions will be kept strictly confidential and will not be revealed to any other person or agency without written permission.

In order to maintain professionalism, therapists are required to be supervised by another therapist during these interactions, client anonymity is paramount.

Confidentiality has some legal limits as well. There are situations where the therapist can be required to reveal information obtained during therapy to another person without permission. These situations involve harm to self, harm to others and any safeguarding concerns.

THERAPEUTIC RELATIONSHIP

It is helpful to remember that our relationship is professional and not social. Our professional relationship is of utmost importance as we work together towards achieving your goals. I am available Monday to Friday from 9am to 5pm and will respond to you as soon as I can. 

ENDINGS

You are in complete control and may end the therapeutic relationship at any time. Endings are an important part of the therapeutic process, in order to manage an ending appropriately, I require at least two weeks’ notice prior to an ending.

SESSIONS AND CANCELATIONS

Sessions last 50 minutes.  I require 48 hours cancelation notice prior to the session, if appointments are not cancelled within this time frame, then fees will still be due. Please note I work in conjunction with the school term and break in school holidays.

FEES 

Fees are payable by cash at the end of each session. Or if you wish to pay by bank transfer please do so before the start of each session. I will supply you with my bank details prior to the first session.

EMERGENCIES

Please understand that I am not a crisis service. In the event of an emergency pls contact your GP or go to your local A&E or call 999.

CANCELLATION

Please contact me if you will not be able to keep an appointment. I require 48 hours’ notice of cancellation. if the appointment is not cancelled within the 48-hour period I would expect the full fee of the missed appointment.

DATA PROTECTION

The only data I collect is name, address, email and telephone number of the parent/carer of the child or young person that I am working with. I am obliged to keep notes of the key issues that is discussed during the sessions and they will be kept for six years, then they will be destroyed by a shredder.

ACKNOWLEDGEMENT AND CONSENT

By your signature below, you are confirming that you have read and understood this consent form.

Please provide your personal and medical information in the form below:

Contract Form
In the event of an emergency; please fill in below name and contact number
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