1. Client Details

Name
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Address
Preferred Contact Method

2. GP Details

GP Address

3. Counselling Agreement

4. Counselling Agreement
I understand that counselling sessions are approximately 60 minutes in duration and that payment is required in advance unless otherwise agreed. As a person-centred therapist and Chartered Fellow Member of the ACCPH, Deborah aims to provide a safe, supportive and non-judgemental environment where I can explore my thoughts, feelings and experiences at a pace that feels comfortable for me. The therapeutic relationship will be based upon empathy, respect, honesty and recognition of my autonomy and personal choice. I understand that information shared within counselling sessions will remain confidential unless there are concerns relating to serious harm, safeguarding, or where disclosure is required by law. Wherever possible, this would be discussed with me first. I understand that I am entering into counselling with A Positive Start CIC under the fee option selected above. I confirm that I have selected the correct counselling option, understand the associated fees, and agree to the counselling agreement and cancellation policy. Counselling sessions are not an emergency service. If you feel at immediate risk or require urgent support, please contact your GP, NHS 24, emergency services, or an appropriate crisis support service
5. Cancellation Policy
I understand that a minimum of 24 hours’ notice is required to cancel or rearrange a session. Sessions cancelled with less than 24 hours’ notice may still be chargeable. If A Positive Start CIC needs to cancel, I will be given as much notice as possible and offered an alternative appointments.

Client Declaration

Client Declaration By typing my full name below, I confirm this acts as my electronic signature and that I agree to the counselling agreement, confidentiality policy, fee agreement and cancellation policy outlined above. Your information will be stored securely in line with GDPR and professional ethical guidelines
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