Consult Agreement

Please read all the way and then complete the form and submit it at the end of the page.

Initial Consultation
This is an opportunity for you to talk about your concerns and the reason for your visit. The first session usually lasts 1 1/2 hours. We will discuss working together and make mutual arrangements for ongoing therapy.

Regularity of Sessions
For therapy to be effective, it is important to have regular sessions. Each session will last one hour (or longer if mutually agreed) and will be arranged on a weekly or fortnightly basis.

Confidentiality and Data
All of our sessions are held in the strictest confidence and fulfil practicing requirements regulated by the UK Health Care Professions Council. I will not disclose any information to a third party, for example, your GP, without your permission. I would only waive your right to this confidentiality should I feel that you may be a danger to yourself or others or by order of a Court.

I am in supervision, as part of my commitment to good practice and in keeping with my professional duties, as outlined by the British Psychological Society and the Health and Care Professions Council. The duty of confidentiality extends to my supervisors, who are also qualified and accredited professionals.

We are registered with the Information Commissioner and comply with the regulations. There are some circumstances where our normal confidentiality would need to be broken. This includes:

If a client is clearly likely to seriously harm him/herself, I may be required to act to prevent you harming yourself.

If there is a clear risk that a client plans to seriously harm another person, I may have a duty to warn the potential victim; or disclose the risk to appropriate public authorities.

If a therapist suspects that abuse of a child or senior citizen may have taken place, the therapist is required to report the suspected abuse.

If you are involved in a court proceeding and a request is made for information concerning your evaluation, diagnosis or treatment, such information may be disclosed if I am ordered by the court to provide it. If you are involved in or contemplating litigation, you should consult with your solicitor to determine whether a court would be likely to order us to disclose information.  

I may present disguised case material in seminars, classes, or scientific writings.  In this situation, all identifying information and Protected Health Information is removed and client confidentiality and anonymity is maintained.

Special note about video conferencing
We will normally conduct video sessions using Zoom, which does not require any personal information from or about you. Before your session you will be sent a link that will securely connect you to your session. We do not record sessions and recommend that you do not either. Zoom will not leave information on your computer, tablet, or phone after the session. You will be provided with a unique link for each session you book. After the session the link will become invalid and anonymous.

Service charges and financial information
Currently (2019) fees are £125 for face-to-face sessions and £100 per hour for videoconference or telephone sessions. You are responsible for paying this fee at each session attended. For remote consultations we will send you an email, which is due upon receipt. We have online payment facilities for debit and credit cards and we accept bank transfers. Please keep current on your payments to ensure there is no interruption to your sessions.

Appointments and cancellation policies
Psychological services are by appointment only for an agreed period of time. Sessions may be arranged face to face, via telephone or videoconferencing. Please provide at least 48 hours notice for any appointments you need to cancel as the booked appointment is reserved specifically for you. With 48 hours or more notice we do not charge for cancellation or change of appointment date. With 24 to 48 hours notice of cancellation or change of appointment date you will be charged half the fee of the appointment. With less than 24 hours notice of cancellation or change of appointment date you will be charged the full fee of the appointment. You will be responsible for the cancelled session fee.

Insurance Claims
Although I am a registered provider with most major insurance providers, we do not file claims on behalf of clients. We can provide a receipt for your payment which you may be able to file with your insurance company, but this will be between you and your insurance company.

Messages and emergency procedures
If you have an emergency please contact your GP as we do not provide emergency or out of hours services.

Please enter your name for billing and identification purposes. Ensure your name matches what will display if you pay using bank transfer to help us credit your payment.
Please complete this if you are acting on behalf of a child under the age of 18. If other circumstances need to be considered contact us for guidance.
Enter as DAY/MONTH/YEAR i.e. 01 JANUARY 1999
We need your email address so we can send you an invoice or other correspondence.
Enter your telephone numbers with the primary one first and separate additional numbers by a comma.
We need your address in order to write to you and for billing purposes if there is a problem with your email.
If you do not want us to leave a message on your voice mail, tell us how you want us to reach you.
Who shall we contact in case of emergency? Include contact details as appropriate such as email, telephone, etc.
By ticking all boxes and submitting this form you are agreeing to the Terms and Condition of this agreement.