NEW CLIENT INFORMATION

Before your sessions start, there is some information that I need from you, as well as some in and outs of therapy that I'd like you to be aware of.

Doing this beforehand allows us to spend more time in our first meeting getting to know each other and thinking about what might be helpful for you. However, if you don't feel sure about providing particular bits of information, or there are parts of the therapy agreement that you would like to talk to me about, I'm more than happy for us to do that when we meet too. If that's the case, please leave the relevant parts blank and we'll come back to it.

First Name

Last Name

Address

Phone

Date of Birth

GP details (and other mental health team if applicable)

Emergency Contact Name and Phone Number (e.g. family/friend)

Terms of Therapy

Ethical Framework

I am a member of British Associations for Counselling and Psychotherapy (BACP) and work in line with their Ethical Framework. You can find this on their website.

Confidentiality

What you tell me will remain between us. The only exceptions to this are:

If I perceive a serious risk of harm to you or someone else.
Where the law requires it, for example, with terrorism, drug trafficking or money laundering. Sometimes I can be asked to give evidence in court. I ask that you let me know if you are currently involved in an ongoing or upcoming court case.
My clinical supervision, which is also bound by confidentiality and the BACP ethical framework.
In the event of my death or sudden illness, I have nominated a clinical executor who has access to client contact information for the sole purpose of informing you and offering alternate arrangements where possible.
If a third-party is paying for the sessions on the behalf of the client, the therapist’s contact with said third-party will be limited to the invoicing process.

Fees

The fee per 50-minute session is £50. Unless we have agreed otherwise, fees are due by bank transfer before the session.

Please give me as much notice as you can if you need to rearrange or cancel a session. If notice of non-attendance is not given by 6pm the day before the appointment, there is a fee of £20.

My privacy policy is available for you to read here.

Additional Client Agreements

If you would like to work with me either on a 'walk and talk' basis or using Trauma Centre Trauma-Sensitive Yoga (TCTSY), please have a look at the relevant sheets here. I will ask you to sign a copy when we meet or, if you change how you want to work, when it becomes relevant.

I declare that I agree to the terms of therapy above

I have read and understood the privacy policy

Thanks for completing the form - I look forward to meeting you!