Counselling/Psychotherapy Agreement

Name:
Tel:
Mobile:
Email address:
Address:
Occupation:
DOB:
Marital Status:
Spouse Name:
Children's Names and DOB:
Spiritual affiliation, if any:

Fees: £50 per hour

Changes: Re-scheduling or cancellation should be done 24 hours before the planned appointment or the full fee will be charged.

Problems: If you say or do anything in a session that you don't feel comfortable with, or if you have any concern with the way we are working, please let me know as soon as possible. For our work to be effective, you have to be honest with me.

Confidentiality: I abide by the Code of Professional Ethics and Conduct of the British Association for Counselling and Psychotherapy (BACP). Anything that you share in the sessions is confidential. I undertake not to use or disclose any information you shared with me during the sessions, with the exception of:

- supervision, though your identity will not be revealed;
- cases where I am required by law to report certain criminal activities, viz. terrorism.

If you intend seriously to harm yourself or others, I will endeavour to work with you and discuss who else needs to know.

Nature of Counselling/Psychotherapy: results are not guaranteed and you take full responsibility for creating your own results. However, when appropriate and with your permission, I can offer you life coaching, hypnotherapy and Reiki in the session.

You have read and agreed with the above.

Client:

Date:

Click to go back to main Counselling/Psychotherapy page

[ Back to top ]

For personal and spiritual wellbeing and growth.

Home | Reiki | Counselling/Psychotherapy | Life Coaching
Forgiveness Workshop | Contact

Copyright 2006 Joyce Chiu Broadbent