CONTACT DETAILS

Please fill out your details below and read the Therapy Contract before submitting.

Preferred name

Full legal name

Pronouns

Date of Birth

Phone number

Address

Method of contact

Please indicate if counsellor may use following methods of contact.

Yes

Phone call

Yes

SMS

Yes

Emergency contact details

Name

Phone number

Optional information

Is there anything you would like your counsellor to know regarding for example disabilities, medical history, allergies, learning needs, known triggers etc?

THERAPY CONTRACT

This document is used to inform you of the terms and conditions and serves as a contract between you and Claudia Kent. If you have any questions or concerns, please do not hesitate to contact kentclaudia@gmail.com or (+44) 075 162 161 15.

You can find out more about counselling on the FAQ page.

service

The service provided is for sessions of 50 minute online or in person counselling on a weekly basis or according to agreement. The session fee is £60 which may be subject to change at the end of each calendar year.

payment

Payment is required 24h prior to the session. Non-payment means a scheduled appointment may not be guaranteed. Payment can be made via invoice which will be emailed to you or by direct bank transfer to:

Bank: Monzo Personal
Sort code: 04-00-04
Account nr: 837 954 49

cancellation

The cancellation policy is 24h and the full session fee will be payable if less than 24h notice is given.

lateness policy

Unless prior contact has been made, the counsellor will wait for 15 minutes after which the session will be concluded and the full fee will be retained.

contact between sessions

Queries relating to appointments and invoicing will be dealt with as soon as possible. Clients may request emergency appointments subject to availability.

ending

You can choose at any time to end the counselling work. If Claudia does not hear back from you within 14 days your file will be closed and the working agreement ended.

Careful consideration will be given to situations where there may be reason to believe that another therapist would be better suited to meet your needs.

confidentiality

You are free to chose what you want to share in counselling, and notes taken during sessions will be stored securely on a password protected platform. Everything discussed verbally and in writing is confidential except in certain situations. If you or another person is thought to be at risk of serious harm the relevant emergency authorities and/or your nominated emergency contact may be informed. Every reasonable effort would then be made to do this in consultation with you.

Please refer to my Privacy Notice document for full details on how your personal data is collected, stored, processed and destroyed. Your personal information will not be disclosed to anyone else except in accordance with the Privacy Notice or applicable law.

professional membership

BACP registered membership number: 00965782.

applicable law

England and Wales, and UK GDPR.

recording policy

Recording of sessions is not permitted by either party unless by prior agreement.

informed consent

Unique Client Code

I hereby agree to the above terms and conditions and give my informed consent for Claudia Kent to provide me with counselling and psychotherapy services.