The purpose of this form is to share some essential principles, which guide my therapeutic practice so that your decision to embark on therapy with me can be based on accurate, informed expectations. Please read this carefully and feel free to ask any questions about what you have read if you need further clarification.

Therapy is a process which relies heavily on building a trusting relationship between the therapist and the client. This takes time for a person to open up and for the therapist to understand what they are struggling with. Psychotherapy is a collaborative effort that requires active participation from both you and your therapist. The approach used will vary depending on your needs, and it may involve discussing uncomfortable topics. There are no guarantees about the outcome of therapy, but studies have shown psychotherapy to be helpful to those who undergo it.

In general, one of the most important rights individuals seeking therapy have involves confidentiality. Information revealed by a client during the sessions will be kept strictly confidential and will not be revealed to any other person or agency without written permission.

To maintain professionalism, therapists are required to be supervised by another therapist during these interactions, and client anonymity is of paramount importance.

Confidentiality has some legal limits as well. There are situations where the therapist can be required to reveal information obtained during therapy to another person without permission. These situations involve harm to self, harm to others and any safeguarding concerns

It is helpful to remember that our relationship is professional and not social. Our professional relationship is of the utmost importance as we work together to achieve your goals. I am available Monday through Friday from 9am to 6pm and will respond to you as soon as possible.

You are in complete control and may end the therapeutic relationship at any time. Endings are an important part of the therapeutic process. To manage an ending appropriately, I require at least two weeks’ notice prior to the end date

Sessions last 50 minutes. I require 24 hours’ notice of cancellation prior to the session. If appointments are not cancelled within this time frame, fees will still be due. If your circumstances change and you can no longer attend the appointment, please notify me by email at this address at least 24 hours prior to your scheduled appointment.

Fees are expected to be paid before or immediately after each session. Payment can be made by cash or bank transfer. Please note, I do not work with any health insurance companies

· Understanding your insurance coverage is important for setting realistic treatment goals.

· I will try to help you navigate your insurance benefits and maximise coverage, but you are ultimately responsible for payment.

· Your insurer may require authorisation before providing reimbursement and may limit the number of sessions that are covered by insurance. If you request additional sessions beyond your insurance coverage, you will be responsible for the total cost of those sessions.

· I recommend contacting your insurance company directly and in advance of our first session to understand your specific mental health coverage benefits and any limitations or pre-authorisation requirements.

· Most insurance companies require a diagnosis to provide coverage and may request additional clinical information (treatment plans, progress notes, etc.). By signing this form, you are granting me permission to share your information with your insurance company to facilitate payment for your covered services.

Please understand that I am not a crisis service. In the event of an emergency, please go to your local A&E, or call 100.

The only data I collect is the name, address, email and telephone number of the person that I am working with. I am obliged to keep notes of the key issues discussed during the sessions, which will be retained for 6 months before being destroyed.

By your signature below, you are confirming that you have read and understood this consent form.

Please provide your personal and medical information in the form below.