Counselling contract with Deborah M. Lynch   PG.Dip.Couns  

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My Details:
Mobile:                                                      Email:

Your name:                                               Address

Date of Birth

Telephone                                                 Email Address

GP Details

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Medication

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Frequency and duration of counselling 

I would recommend weekly sessions, as this enables the therapy process to proceed smoothly.

Fees and Cancellation Policy

My fees are £50.00 per 60 minute session. If a session is cancelled with less than 24 hours notice you will incur the full fee. This is to ensure continuity in our work together.

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Confidentiality

Our sessions are confidential. If you feel someone else needs information about our sessions please let me know at the beginning of the sessions.
Exceptions
There may be exceptions to confidentiality rules:
If I think there is a serious risk of harm to yourself or others or if I cannot contact you and suspect you are in danger. E.g. If you have not been seen for several days and family feel concerned or where there is a legal requirement to disclose information. E.g. Violent threats, terrorism etc. I will talk this through with you beforehand if possible.

Notes and Record Keeping

I store personal information, (Name, DOB, address etc. & information relevant to the counselling process. If you have confidentiality concerns please discuss it with me.

Influence of alcohol or substances
Sessions will not take place if you are under the influence of alcohol or substances. If this causes the session to be cancelled the full fee is applicable.
Signed and Dated

Counsellor name: Deborah Lynch                                    Client Name:

Signature:                                                                        Signature:

Date:                                                                                Date: