Informed Consent for Therapy

Please read this before your first session and ask about anything unclear.

Your name (required)Date of birth (required)Email address (required)Emergency contact - name, relationship and number (required)Your doctor's practice

Confidentiality

What you say in sessions is confidential. There are limits, and they are: if I believe you are at serious risk of harming yourself; if I believe someone else is at risk, including a child or vulnerable adult; if I am required to disclose by a court; and if disclosure is required by law, for example in relation to terrorism. I also discuss my work anonymously in clinical supervision, which is a professional requirement.

I understand the limits of confidentiality described above (required)

I understand my case may be discussed anonymously in supervision (required)

I agree that my doctor may be contacted if there is serious concern for my safety (required)

Records

I keep brief notes of our sessions, stored securely. You have the right to ask what is held about you. Notes are kept for the period my professional body requires and then destroyed.

I understand notes are kept and how long for (required)

May I contact you by email? (required)

Fees and attendance

Fees, session length and the cancellation policy are set out in the information I have sent you. Sessions cancelled with less than the stated notice are normally charged, because the time has been reserved for you.

I understand the fees and how to pay them (required)

I understand the cancellation policy (required)

Consent

I am attending voluntarily and understand I can stop at any time (required)

I understand therapy can be difficult at times and that no particular outcome can be promised (required)

I consent to beginning therapy (required)

Anything you'd like to ask before we start?