Confidentiality , Ethics & Safety:
THERAPY AGREEMENT
Name:
Home Address:
Contact Numbers:
D.O.B:
Doctor/Consultant details:
Safety / Duty of Care:
I understand I have a primary responsibility concerning safety to Self and Others and the need to keep my therapist informed.
Covid:
My therapist has received up to date inoculations, is mindful of when to use LTF and PCR testing and practices all reasonable measures to minimise transmission.
I agree to provide the same measure of protection.
{Please do not attend if you have been in contact with a confirmed case within 7days}
Confidentiality and GDPR:
I give my permission for confidential anonymous notes to be taken and for clinical material to be discussed in supervision in line with my rights under the GDPR of 2018. I understand that confidentiality will be prioritised at all times within the limits defined by statutory regulation.
[NB: a coded system is used to maintain privacy, anonymity is maintained during supervision. When therapy ends emails and phone numbers are removed from electronic media and coded records of attendance are kept for the statutory time at secure private premises before being erased. Client details can only be released following a judicial process whereupon all relevant parties are first informed].
UKCP:
I understand that my therapist is a long-standing member of UKCP and is committed to abiding by its ethical framework at all times.
Cancellation:
I understand that sessions are 50 mins for individuals and 75 mins for couples, with payment due on the day. A contractual commitment to attend sessions regularly for a mutually agreed time frame is undertaken from the start as the basis for a productive outcome. Payment on the day with a 48 hour cancellation policy.
Signed:
Dated: