Your personal details are needed for three reasons:


1) Without knowing your identity I cannot have deemed to have obtained informed consent (for counselling).  

2) In the normal course of counselling there should be no need to contact you between sessions. However I may need to cancel a session at short notice due to unforeseen circumstances such as illness, in this case I would need to email you or text you (and I would appreciate you doing the same).

3) If an emergency situation arouse, I may need to inform someone of your whereabouts.  

At the moment the possibilities are Skype or FaceTime (with an embedded counselling room due to be added by March 2013).  So in this section please confirm which you would like to use and supply the necessary ID or associated Email address (possibly phone number) so I know who is calling me / adding me / sending me a contact request (many people use aliases online and I would not like to reject you by mistake!)

In all communications with Central England Counselling, the Client agrees to honestly represent their identity and Personal Information.


          The Client must be over 16 years of age.

                                                                  

The Counselling sessions will take place on ‘online’


Each Counselling session will last between 55 and 65 minutes (with an intended average of 60 minutes), at the discretion of the Counsellor.


The Counselling will be open ended (not limited to a specific number of sessions) and will be periodically reviewed by the Client and Counsellor, to assess and agree that it is of benefit to the client.


The Client will be responsible for initiating the call at the booked time.


Each session will start at the agreed/booked time. If the Client is late ‘logging on’ the session length can only be extend beyond the original agreed end time at the discretion, good will and availability of the Counsellor.


The Client agrees to give the Counsellor as much notice as possible if the need to cancel arises.  Two cancellations in a row by the client will deemed to have broken any contract or commitment (legal or ethical) the Counsellor has to the Client, and the Counsellor will have the right to refuse any further bookings by the Client.


          The Counsellor agrees to give the client as much notice as possible of any illness or event that may prevent them being available for a scheduled session. The Counsellor will try to offer an alternative arrangement.


The Counsellor reserves the right to cancel or curtail a session if the Cient appears to be unduly under the influence of alcohol or other drugs.


The Counsellor is a member of the British Association of Counsellors & Psychotherapists and will work within their ethical framework.


           Central England Counselling agree not communicate your Personal Information to anyone without your consent, other than the following exceptions:


           1. While receiving regular supervision (by another qualified counsellor) which is a requirement of the British Association of Counsellors and Psychotherapists.  Supervision may involve the Counsellor disclosing your personal information to their Supervisor.  The Supervisor is in turn bound by the same rules of confidentiality as the Counsellor.

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           2. Counsellors have both a legal and ethical requirement to report any suspicion of child abuse or risk of child abuse to appropriate child protection authorities.


           3. If there is reason to believe that a person's life (yours or that of another) may be in danger the situation will be reported to an appropriate authority (in the case of it being your life the appropriate action may be agreed between us).


            4. If there is reason to believe that a person (you or another) is at risk of serious harm, the situation will be reported to an appropriate authority (in the case of serious harm to yourself the appropriate action may be agreed between us).


            4. Courts of law may have the power to demand the release of your records if you are involved in a court case and the court believes your communications with your Counsellor has a bearing on that case.


            5) Counsellors are responsible by UK law to report acts or potential acts of terrorism serious crime or money laundering.


           Central England Counselling's ability to fulfil these obligations are limited by the information that you provide.


           You are advised to check and keep contact details up to date, failure to do so releases Central England Counselling from any ethical and/or legal obligation to warn of life threatening situations.  You are also advised that even if Central England Counselling has your correct contact details we may in practice only become aware of any life threatening situations AFTER those situations have arisen and past.


  Whenever possible confidentiality will not be broken without first discussing the issue with the client.


 Records – Brief written ‘session notes’ may be kept by the Counsellor.  They will be kept in a secure place, and separate from any names or contact details (notes and names or contact details will be linked by a code system known only to the Counsellor).  In the event of the Counsellor’s death they will be destroyed (by the Counsellor’s Supervisor) otherwise they will routinely be destroyed after two years.  Client’s personal details and notes will NEVER be passed to a 3rd party unless specifically requested by the Client or demanded by a court of law.    

The Counsellor and Client agree that without the explicit permission of the other being obtained beforehand a session may not be recorded under any circumstances.


 Fees: The cost of each session will be 40.00 GBP. The Client will be required to book (and pay) for each session before the session is due to take place.  The Counsellor is under no obligation to continue the counselling sessions if the fee is not paid.


 Further conditions, may be added to this contract with the mutual consent of the Client and Counsellor.

           


 The Client agrees to be bound by Internet regulations, policies and procedures.


            The Cient agrees to comply with all applicable local, national and international laws and regulations.


            It is good practice to ensure that your computer is running anti-virus software.


           Central England Counselling does not guarantee that its online Counselling Service will be uninterrupted nor does it guarantees the availability, reliability, timeliness or appropriateness of the Service.


            In the event of a session terminating before time due to technical difficulties judged (by the Counsellor) to be the fault of the Counsellor’s equipment or connection ...


           a) If the session has run less than 35 minutes, the Client will have the choice of a refund for that session or their next session (55-65 minutes) free of charge.


           b) If the session has run between 35 and 50 minutes the Counsellor will agree to adding that time to the next session if the Client wishes, but no refund will be given.


           c) If the session has run for 50 minute it will deemed to have been a completed session.


 In the event of a session terminating before time due to technical difficulties judged (by the Counsellor) to be the fault of the Clients equipment or connection ...


           The Client accepts and agrees that the Counsellor is under no obligation to offer any further time or refund.


           Although not forming part of these conditions in any way: the Counsellor may or may not suggest as a good will gesture.


           a) A session lasting less than 35 minutes long may be re-arranged free of charge.


           b) In a session lasting between 35 and 50 minute the missing time may be added to the next session.


           c)  A session lasting over 50 minutes will be deemed to have been completed.


           The Client agrees that it is the Counsellor’s sole prerogative to decide those equipment or connection is at fault and that this decision is final, and no correspondence will be entered into regarding this decision after it has been made.


           Central England Counselling is not responsible for any damages whatsoever as a result of the loss of use of computer equipment or data.  The sole remedy is for the Client to discontinue their use of Central England Counselling’s Online Services.


            The Client agrees that Central England Counselling cannot be held responsible for any third party claim, demand, or damage, including Legal fees, arising out of your use of Central England Counselling’s Online Counselling Service


           Any rights not expressly granted herein are reserved.

There are some circumstance in which I cannot offer you Online Counselling.

There are also some circumstances in which you may like to reflect on whether Online Counselling is the best option for you.  If any of the following situations are applicable to you please follow the hyper-link for further information.


You are living outside the UK?


You are under the age of 18


You are uncomfortable or inexperienced using a computer?


You are currently seeing another counsellor?


You are feeling suicidal?


You are taking medication?

Sometime medication and Counselling do not mix!  In a first session I will usually ask if you are on any medication.  Due to the many types of medication and their trade names I will often not know what effects or side-effects that medication may have .. I will usually go and ‘look it up’ after the first session.  It is possibly useful therefore if I have advance knowledge of any medication that you think may have an effect on our ‘Counselling Relationship’ or are unsure of.  This is an optional discloser (just as it will be in the first session) but I cannot be held responsible if you conceal the fact you are on a medication, that later proves to have a bearing on the ‘Counselling’ (this would usually be a ‘strong’ anti-depressant or an anti-psychotic drug).  So if you would like to: please list the name and dosage of any medication you are currently taking in the box below.

Part 1 ... Pre-assessment form

Part 2 ... Personal Details

Part 4 ...  Central England Counselling's Terms of Use

Part 3 ... The counselling contract

Part 6 ... Medication


Please check you details carefully.  I have no way of knowing/checking if the details you are giving me are correct.  If they are incorrect this obviously limits what I could do in an emergency situation.



If you would like to give me the details of an emergency contact (relative, friend doctor) please enter them in the box below (this is optional).  This contact would only ever be used in an emergency situation and if possible your permission would be obtained beforehand.  For example: if you were taken ill while we were online or if I thought that you were in danger of causing yourself serious physical harm (although I may be prepared to agree/contract to taking no action in these circumstances).

Part 5  .... How would you like to connect

How would you like to be contacted in a non-emergency situation.

For example: I need to cancel at short notice due to ill health.

Send me an Email:

Call my Mobile Phone:

Call my Land-line Phone:

Text my Mobile:

I confirm that: I have read understand and accept to the above contract

Counsellors Name:

Date:

Ken Beckett

Clients Name: