SUPERVISION AGREEMENT

Name:
Tel:
Mobile:
Email address:
Address:
Occupation:
DOB:
Marital Status:
Spouse Name:
Childrens Names and DOB:
Spiritual affiliation, if any:
Where you heard of me:

Fees: £30 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.

Confidentiality: I abide by the Code of Professional Ethics and Conduct of the 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, apart from presenting them to my consultant supervisor, though your identity will not be revealed;

I am also registered with the ICO (Information Commissioner's Office) which is responsible for data protection.

Nature of Supervision: results are not guaranteed and you take full responsibility for creating your own results.

You have read and agreed with the above.

Client:

Date:

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