Informed Consent Form

Please read the following information carefully before consenting to the terms and conditions.

Confidentiality

As a client, your therapy sessions are confidential. I cannot and will not tell anyone else what you have told me, or even that you are in therapy with me, without your prior written permission. You may direct me to share information with whomever you choose to and you can change your mind and revoke the permission at any point of time.

No information recorded at any point on the website will be shared or disclosed without written consent from the client.

The circumstances in which confidentiality may be broken include:

Where you as a client give consent for confidentiality to be broken.
Where I feel it is appropriate to consult with, or involve other professionals, in circumstances where there is a risk of harm to you, the client or to a third party. In such cases, I will aim to discuss any action with you first and seek to gain your cooperation.
Where I am legally compelled by a court of law. I may consult with my supervisor (if necessary) to provide you with the best possible care. Your identification details are kept confidential during these professional discussions.

Rescheduling/Cancellation Policy

Any cancellation/rescheduling of appointment requires a minimum of 24 hours notice. If less than 24 hours notice is given, the complete fee for the session will be retained. There will be a waiting period of 15 minutes from the scheduled time, after which the session would stand canceled. All refunds initiated will be credited to your bank account in 6-8 business days.
This practice of being charged for missed sessions or late cancellations is a standard practice in the field, and takes into account that you are not just paying for services rendered, but reserving a time slot which cannot be offered to someone else on short notice. Please note that if a prior agreement has been made between the client and the therapist regarding their absence then the same shall not be held in their case.

Limits for Counseling

It is not okay to attend counselling sessions whilst under the influence of drink or drugs or to harm yourself or others in any way during the sessions. I would need to be informed if you are prescribed any medication.

We do not usually work with a client who is seeing another therapist, if you did see someone else this is something that I would need to know about and that we could discuss.

Acknowledgement and Consent for Psychotherapy

I have read and discussed the above information with my therapist. I understand the limits to confidentiality required by law. I understand the fee per session and my rights and responsibilities as a client and my therapists’ responsibility to me. I voluntarily agree to participate in psychotherapy sessions.