Client Contract

This client contract is designed to provide an agreed contract which will assist the process of counselling.

Please read through it carefully then complete the online form. Should you have any questions or require further details please contact Anne Lindley-French on anne@gardengate.org.uk or 07961190749.

Click here to complete an online version of this form.  If you would like a copy for your records you can download a digital copy or print by right mouse clicking from your PC and selecting the Print option.

Garden Gate Therapy – Client Contract

Name:

Address:

Postcode:

Tel. Home:

Tel. Mobile:

Email:

OK to leave a phone message?     Yes/No

Can I contact you by email?     Yes/No

Does your partner know you have contacted a counsellor?     Yes/No

Are you available to attend regular weekly sessions?     Yes/No

Are you registered disabled?     Yes/No

If so, do you have any special requirements?

Sharing a Commitment to the Process of Counselling: Counselling is a process which works on many different emotional levels, which can be difficult and painful at times. Our duty of care to our clients is to support them through this process and it is essential that planned sessions are not missed and that the end of the therapy is managed thoughtfully and safely. Please be mindful of this and make every effort to ensure that interruptions to the therapy are kept to a minimum. We will be there for all agreed sessions and will only cancel a session in the event of illness or an emergency.

Client Cancellations: If you are unable to attend a session please contact your Counsellor/Coach via text or mobile phone as soon as you can to notify them. We require 24 hours’ notice in order to cancel a session and no fee is payable. In the event that you are not able to give 24 hours’ notice the full fee is payable.

Your counsellor emergency contact number: Anne Lindley-French 07961190749

Confidentiality: We hold information about our clients and the counselling they receive in confidence. This means that we will not normally give your name, or any information about you, to anyone outside. There are exceptional cases where we might ethically or legally be required to give information to relevant authorities, for example if we had reason to believe that someone, especially a child, is at serious risk of harm, to prevent a miscarriage of justice, if a terrorist act is being planned or instigated. If you come with a partner or your family, we may suggest seeing each of you individually. It is important for you to know that what is said in those individual sessions will be confidential and not shared with your partner or family.

Data Protection: We keep confidential records and statistics about clients and all records are kept securely subject to the Data Protection Act 1998. We recognises that on rare occasions clients may wish to exercise their rights under the Data Protection Act 1998 and make a subject access request in respect of their personal information held by us. Often during counselling information is provided by more than one individual. In these cases we will only release information if consent has been given by all of the individuals involved. If at any time you wish to exercise your right under the Act you should put your request in writing to us, enclose a cheque for £10 and provide evidence of your identity such as a copy of your passport or driver’s licence and proof of your address. On receipt we will respond to your request within 40 calendar days. Our response to a valid subject access request will normally be in the form of a schedule listing and describing the personal data we hold. By signing this consent form below you acknowledge that you understand and agree with our subject access policy for counselling notes.

Reports and Client Records: Occasionally we are asked by clients or external agencies such as Social Services or the NHS to write reports on the progress made in counselling. We are not normally in a position to do this because of our duty of confidentiality to clients and because we are not trained in the specialist areas of diagnosis or social work assessment. However, in some circumstances, and on receipt of written consent from the client(s) who attended counselling, we may provide brief information about the dates and number of sessions attended. We could be asked by clients, their solicitors, the police and the courts for access to the client records. These are not suitable as evidence in legal proceedings and we reserve the right to resist legal requests to produce the records in court. We do this in order to protect our duty of confidentiality to all clients and to preserve our reputation as providers of confidential counselling.

Domestic Violence: Violence and abuse is an issue for some clients having counselling for their relationship. In some cases working with couples or family members together may not be safe. If this is so, we will help each person to get individual specialist support from alternative counsellors or another agency.

Privacy – Unauthorised Electronic Recording: In order for you to work safely and effectively it is important that the privacy of the work is respected. Please, therefore, do not attempt to record your counselling session using devices such as mobile phones or Dictaphones. If it is found that recordings have been made covertly, counselling services for the individual responsible will be discontinued immediately and we reserve the right to seek legal advice regarding possible further action.

Privacy- Authorised Electronic Recording: Some counsellors regularly use audio or video recording in their work and in these circumstances you will be asked to give your written consent for this to happen. The consent will specify all the ways in which the recording will be used (for example training, supervision or research) and will specify how and when the recording will be destroyed.

Code of Ethics and Practice: We are required to comply with the code of ethics and practice that is appropriate to the work we undertake. All of our counselling is covered by the British Association for Counselling & Psychotherapy’s Ethical Framework for Good Practice.

Feedback and Complaints: If you have any feedback about the service you receive, or you are not satisfied with your experience, please tell us. It is possible that we can resolve your complaint and we welcome all feedback. If you make a compliant we will always take it seriously, as it allows us to improve the service we offer to our clients. We may invite you to provide voluntary feedback once the counselling is ended so that we can evaluate and improve our work.

Client Agreement

Name:

Signature:

Date:

Click here to complete an online version of this form or right mouse click from your PC and select the Print option to print a hard copy.