07786 749104

Terms and Conditions

CLIENT ASSESSMENT AND T&C (For information only, will completed on initial session)

Date ……………………………

First Name…………………………………………………………..…………

Last Name……………………………………………………………………..

Date of Birth ………………………………………… if under 18 parent or guardian to authorise treatment (see below)

Address …………………………………………………………………………..……….

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Home Tel………… ……………………………………………………………..

Mobile Tel…………………………..……………………………………………

Email………………..……………………………………………………………

Preferred method of contact in relation to therapy? ……..…………………

Can TH Counselling leave a message? Y/N

Is NOK/partner aware of client’s therapy? Y/N

NOK name and address……………………………………………………..

………………………………………………………………………………….

Home Tel ……………………… Mobile Tel ……………………..…………

Nature of the enquiry…………………………………………….………….

Preferred Method (circle) Walk & Talk Counselling Room Online

Where did you hear of TH COunselling?………………………………….

Medical Questionnaire

General Health (circle) poor good very good excellent

Any current or on-going medical conditions? (please provide a brief outline)………………………………………………………………………………………..

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Please list any medication you are currently taking.………………………………………………………………………….

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GP details………………………………………………………………………

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Ethical standards
I am a registered member of the British Association of Counsellors and Psychotherapists and as such follow their Ethical Framework. A copy of this can be obtained from me or by going to:https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/

This is a mutually agreed contract between:

Tanya Hayter of TH Counselling and Training, Counsellor and,

……………………………………………………………………………………. the client.
It states our responsibilities for the time that you engage in counselling with me.

Aims of Counselling
The overall aims of your counselling with me will have been discussed and agreed in our initial meeting. However other issues may emerge as our work together progresses.

Confidentiality
Anything discussed in our work together will be held in strict confidence. As part of my ongoing professional development I may discuss some of our work with my supervisor. Your identity or other personal information will not be shared. The only time that confidentiality would be broken is if I felt you may harm yourself or others, always provided that such confidentiality is neither inconsistent with the therapist’s own safety or the safety of the client, the client’s family members or other members of the public nor in contravention of any legal action (i.e. criminal, coroner or civil court cases where a court order is made demanding disclosure) or legal requirement (e.g. Children’s Acts).

Our sessions
Our counselling sessions will last for 50 minutes. If a session needs to be cancelled clients shall give 48 hours notice, less than 48 hours will incur the payment of the cancelled session. The expected length of therapy will be discussed at the initial meeting. We will review progress at regular intervals to be agreed by client and therapist.

Insurance
I hold both public liability and professionally indemnity insurance. Please ask if you would like to see these.

By signing the Initial consultation form you confirm that you have read, understood and agree with the terms and conditions of this contract and that we have discussed terms and conditions,

Tanya Hayter ………………………………………date……………..………

Client………………………….……………………date………………………