Personal Information requested:

Only if relevent to your reason/s for attending counselling

If you are paying via an Health Insurance Policy, please state which Insurance provider and also complete the following:

With your consent, I shall use the above information to provide you with a counselling / psychotherapy service. This may include contacting you and or your insurer about appointments/payment and possibly identifying you with your GP or the emergency services where there is a concern about your safety/well-being. 

 

In addition to the above information about you I may keep some brief factual notes as a record of sessions held.

 

I am committed to maintaining your privacy and will only hold minimal information about you for the shortest period of time required in order to provide you with a good service. As such I will hold your information securely* for the duration of our contract and for three months after our contract has ended. After this time, I will delete all personal information held.

N.B. Any texts, voicemails and emails may be deleted sooner i.e. when the purpose for which they are useful has passed.

 

You have the right to: see the information I hold about you, request that your information be changed or updated so that it is accurate and request that your information be deleted.

 

If you have any questions or concerns about how I handle your information, in the first instance please contact me, Vicki Routh, the data controller for Vicki Routh Counselling. If your complaint is not resolved to your satisfaction, you can contact the Data Protection Regulator: Information Commissioner's Office, Wycliffe House, Wilmslow, SK9 5AF, www.ico.org.uk/global/contact-us/email

 

Please sign below to show your consent for me to hold and use your information as described:

*Please see the privacy notice on my website for more detailed information on how will use and protect any information you give to me when you use this service.

 

 

Terms & conditions:

The information provided here makes up the general terms and conditions of your contract with me to provide you with a counselling/psychotherapy service. Please see the privacy notice on my website for more detailed information on how I will use and protect any information you give to me when you use this service.

 

Ethics, confidentiality & record keeping

As a BACP Registered and Accredited Counsellor / Psychotherapist (MBACP Accred), I am committed to providing you with a confidential counselling service in line with The British Association for Counselling and Psychotherapy's (BACP) Ethical Framework which can be found at www.bacp.co.uk

 

As required by BACP I discuss my client work with my supervisor/s in order to ensure that I am offering you a good service. I will not be speaking to anyone else about our work together unless I am ethically or legally required to do so i.e. if information is disclosed relating to your own or another's safety (with particular concern for you, children, and vulnerable adults), or information is shared relating to terrorism or other crimes that the law requires me to disclose.

If we meet outside of the therapy room, I will not identify myself as knowing you in order to protect both your own and my privacy.

I am committed to keeping any personal or sensitive information you give me safe and secure*.

 

Attendance, cancellation, missed appointments & rescheduling

Sessions are weekly (unless a different frequency has been contracted). If (for any reason) you can't make your agreed appointment day/time but you are able to attend at another time that I can offer in the same week, then you may reschedule your appointment. However, if you are not able to reschedule in this way, payment for the missed session is still required to be made. Payment for any sessions not attended must be made before any further sessions can be arranged.

N.B. Where payment for sessions is usually via an insurance policy, you will be required to make payment yourself for any appointments not attended.

 

The cost for a 50 min session of individual counselling/ psychotherapy is £65-£90 and for couple counselling £80-£120. Session fees are payable weekly by bank transfer, preferably in advance of your session and no later than the day of your session.

N.B. Where payment for sessions is via an insurance policy, you will be required to make payment yourself for any excess on the policy.

 

Ending counselling

It is important to pay attention to when and how to end counselling. It is not usually helpful to end without notice. If you are thinking about ending your counselling commitment, please discuss this with me. We can decide together how many more sessions to have together, at what frequency to hold those sessions and what to focus on during that time.

 

Please sign below to show your agreement to the above terms and conditions:

*Please see the privacy notice on my website for more detailed information on how I will use and protect any information you give to me when you use this service.