• JACQUI CRAFFORD COUNSELLING AGREEMENT

    jacquicraffordcounselling.co.za | info@jacquicraffordcounselling.co.za | 064 557 3965 designated with ASCHP - MEMBERSHIP NR: WC25/17139

  • PARENT / GAURDIAN INFORMATION

  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • ACCOUNT INFORMATION

    Person Responsible for the Account
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • CHILD INFORMATION

  • Date of Birth
     - -
  • Child lives with:
  • How did you hear about counselling or who referred you?
  • (Please tick all that apply or describe below)


  • Confidentiality and Informed Consent
    I understand that the information shared is confidential and will only be used for the purpose of counselling, in accordance with the ASCHP Code of Ethics and Protection of Personal Information Act (POPIA).
    I understand that confidentiality may be broken only if there is a risk of harm to the child or others, or if required by law.

          and   Pick a Date

  • PURPOSE AND AGREEMENT

  •  

    1. Purpose of Counselling
    Counselling offers a safe, confidential space to explore personal, emotional, social, or relational challenges. The aim is to promote self-awareness, emotional regulation, growth, and wellbeing.

    The counsellor will work collaboratively with the client, within the ASCHP scope of practice, to facilitate emotional wellness and practical coping strategies.

    2. Nature and Scope of Service
    The counsellor is designated with the Association for Supportive Counsellors and Holistic Practitioners (ASCHP) and abides by its Code of Ethics and Conduct.
    Counselling is not psychotherapy, psychiatry, or a medical service. Where necessary, referrals will be made to other professionals (e.g., psychologist, social worker, or medical doctor).
    Sessions are typically 45–60 minutes in length.
    The number of sessions will depend on client needs and progress, as mutually agreed.

    3. Confidentiality
    All sessions are treated with strict confidentiality. Information will only be shared under the following exceptions:

    • The counsellor is legally required to disclose information (e.g., risk of harm to self or others, child abuse, or a court order).
    • Supervision or peer consultation may occur in a professional and anonymized manner.
    • The client provides written consent to share information with another professional or third party.
    • Confidential notes are securely stored in accordance with the Protection of Personal Information Act (POPIA) and ASCHP standards.

    4. Counselling Process and Responsibilities
    Counselling is a collaborative process requiring honesty, participation, and respect.
    The counsellor will maintain professional boundaries at all times.
    The client agrees to attend sessions punctually and notify the counsellor of cancellations at least 24 hours in advance.
    The counsellor reserves the right to end counselling if boundaries are violated or if the client’s needs fall outside the counsellor’s professional scope.

     

    5. Pricing Structure 

    Discovery session  One introductory session to explore your needs, goals, and the counselling process. R 550 
    Individual Package (4 Sessions) A structured short-term counselling package focused on individual growth and emotional support. 

    R 1650
    Child & Teen Counselling (4 Sessions)  For children  and teens (4 - 18 years) focusing on emotional regulation, confidence, and social wellbeing. R 1 450
    Family Package (6 Sessions)  For families seeking to strengthen communication, relationships, and connection at home.  R 3200

     

    6. Transition from Individual / Child &Teen Counselling to Family Counselling
    Sometimes, after the initial or first few sessions, it becomes clear that family dynamics need to be addressed together.
    In that case:The first session(s) already completed will be charged at the session rate included in the original package (e.g., child/teen or discovery session).
    The counselling plan and fee structure will then shift to the Family Package rate from that point forward. You’ll only pay the balance of the new package (minus what you’ve already paid).

    7. Fees and Payment
    Payment is due at or before each session. Missed sessions without notice will be charged in full.  BANKING DETAILS: JL CRAFFORD; CAPITEC;  2422701791; BR CODE: 470010; REFERENCE: CLIENT NAME AND SURNAME 

    8. Record Keeping
    Brief notes of each session are kept for professional purposes, stored securely, and retained according to ASCHP and legal requirements. 

    9. Consent and Termination
    Clients may withdraw from counselling at any time. The counsellor may also recommend termination or referral if it is in the best interest of the client.
    Both parties commit to ending counselling respectfully, preferably with a final closure session.

    10. Complaints Procedure
    If a client is dissatisfied with the service, they are encouraged to discuss the concern directly with the counsellor.
    If unresolved, a formal complaint may be lodged with the ASCHP Ethics Committee at www.aschp.net.

    11. Legal Limitations of Service
    The purpose of counselling is to support personal and family wellbeing. In line with ASCHP policies and ethical guidelines, I do not provide court testimony, custody recommendations, or legal reports.
    Should such documentation be required, I will assist by referring you to an appropriate professional registered for forensic or legal work (e.g., a psychologist or social worker).

    PARENTAL CONSENT

    1. Informed Parental Consent
    I understand that counselling is provided to support my child’s emotional, social, and behavioural wellbeing. I consent to my child receiving counselling services and understand that the counsellor operates within the ASCHP ethical framework.


    2. Confidentiality for Minors
    I acknowledge that while I am my child’s guardian, confidentiality is essential for effective counselling. The counsellor will not share specific details of sessions unless: The child provides consent; There is a risk of harm; or Disclosure is required by law. General feedback regarding progress or themes may be shared where appropriate.

    3. Parental Involvement
    Parents may be invited for feedback sessions, parent–child sessions, or consultations to support progress. Open communication between counsellor, parent, and school (if applicable) will occur only with appropriate consent.

  • Client Declaration
    I have read and understood the information above. I understand the nature of the counselling process, confidentiality, and my rights and responsibilities. Please complete:       and   Pick a Date

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