Therapy Agreement

Between: _______________________________________________                                                                    

Name: _______________________________________________                                                                   

Address: _______________________________________________

_____________________________________________________________

_____________________________________________________________    

Phone: ______________________________________________

                    
Email: ______________________________________________                                                                                                             

And the therapist: Miss Anita Clements                                   

1. This contract contains the terms and conditions of our work together.

2. We agree to work together to address the issue discussed. It must be noted that no guarantee of a cure can be given.

3. The cost of each session is £_____  per session  (subject to the type of therapy required.) Payable 24 hours before the session.

4. Payment will still be required for any sessions cancelled (unless more than 24 hours notice is given)

5. Contact between sessions will be made only via email or telephone.

6. It is advised that any additional assistance given, such as voice recording, should be used regularly in between sessions.

7. Any antisocial or inappropriate behaviour will result in the sessions and contract being terminated.

8. Confidentiality is of paramount importance, there are however some situations where confidentiality will need to be suspended and it is possible that other agencies will need to be informed.  For example; disclosure of possible harm to others, any involvement in terrorist activities or drug related crime. Confidentiality would also be broken in the event of a Court order being served demanding disclosure. Whilst your case may be discussed with a supervisor, anonymity will be observed.

9. Records of sessions and all relating documentation will be held in accordance to GDPR requirements, meaning that all records will kept in locked cabinets, electronic data encrypted and   information will only be kept for the required length of time. All records will be securely destroyed.

10. Your GP should be consulted before therapy begins if you have any medical conditions or take medication on a regular basis.

11. Should you wish to make a complaint, please firstly speak with myself to see if the problem can be rectified. If you are not satisfied you can contact:

The National Counselling Society on 01903 213683 (This number is available Monday to Friday 9.30am to 4.00pm). Alternatively please email conduct@nationalcounsellingsociety.org

The National Hypnotherapy Society on 01903 213683 (This number is available Monday to Friday 9.30am to 4.00pm). Alternatively please email conduct@nationalhypnotherapysociety.org

Client Signature:________________________________________  Therapist Signature:_____________________________________________

Date: _____/_____/_____