Client Consultation & Consent Form
Before your first consultation please follow through with these 2 easy steps:
1/ Please read all the information below
2/ Complete the online form below & click SUBMIT
CLIENT GENERAL INFORMATION
The following information is designed to help you understand the therapy process. As a client you have certain rights that are important for you to understand. If you have any questions regarding anything that is explained below please do not hesitate to ask.
Sessions are generally 55minutes in duration unless pre-organised to be longer. When you make an appointment this time is reserved especially for you so could you please let me know, at least 24hrs in advance, if you are unable to attend so that I have time to offer your appointment to someone else.
Without 24hrs notice you may be charged a cancellation fee or the full fee.
Please be on time for your appointment. If you are late I will need to shorten the length of your appointment so as not to inconvenience the next client. Thankyou for your understanding on this.
Sessions can be a one-off appointment, however in most cases a series of sessions are needed. These are usually done weekly or fortnightly and last as long as is necessary depending on what is needed.
Fees are to be paid on the day of the consultation.
Clients attend sessions on the understanding that they take full responsibility for their session, and may withdraw consent at any time.
This consent form will remain active for any future visits and other forms of consultation unless otherwise notified.
If you have any concerns at any time please feel free to discuss them with me at any time.
You have the right to confidentiality in regards to everything that is discussed in your sessions, and this right is protected by law.
Any personal information gathered by me will remain confidential and secure except when:
It is subpoenaed by a court. This is unlikely but in certain events it is possible.
Failure to disclose the information would in my reasonable belief place you and/or another person at serious risk to life, health or safety
Your prior approval has been obtained to:
1. Provide written/verbal report to another professional or agency. E.g. A GP or a lawyer; or
2. Discuss the material with another person. E.g. a parent, partner or employer
Disclosure is otherwise required by law, including mandatory reporting of minors at risk of harm, putting property at risk or admitting having committed a crime or forming the intention to do so.
In the interests of professional development and to provide the best possible service to my clients, I work with a supervisor. I may consult with this supervisor but no names are revealed and any information provided by you cannot be released to anyone outside of this professional arrangement without your written permission.
All communications between you and me (emails, phone calls, reports etc.) become part of your clinical records, which are stored in your client file. Client files are held in a secure filing cabinet that is accessible only by myself.
NOTE: if after reading this document you are at all unclear about anything,
please ask prior to the commencement of your session/appointment