Client Contract – Terms And Conditions
Contact : Gregory May
Email: axiom.integrative.psychotherapy@gmail.com
Mobile: 07824535709
Session Location: 46 Radipole Road
Parsons Green
London
SW6
Terms and Conditions
NOTE: Counsellor / Therapist are used interchangeably in the following document.
I have been advised by Gregory May the scope of counselling / psychotherapy practice and I give my full consent to receiving counselling therapy sessions from Gregory May in today’s session and in any future session.
2. I understand that results vary and that the above named therapist may not guarantee results.
3. I understand that counselling therapy is not a replacement for medical treatment, or psychiatric services. I also understand that the therapist does not treat, prescribe for or diagnose any condition.
4. I understand that the counsellor is a facilitator of talking therapy.
5. I am aware and understand that in some cases it may be necessary for the therapist to respectfully ask that I do some writing and reading . I give my consent to do so in order to help to progress the therapeutic process .
6. I have been advised that I am free to terminate any or all sessions at any time. I have agreed to participate in each session to the best of my ability.
7. I have accurately provided background information as requested by the counsellor.
8. I understand that confidentially regarding my sessions will be honoured between Gregory May and me. This same confidentially is respected when working with minors under the age of eighteen.
9. I understand that, depending on the state of my mental health, further psychiatric treatment may be needed and will be suggested to me and documented by Gregory May if he determines my situation to be outside the scope of counselling and psychotherapy.
10. I agree to pay Axiom Integrative Psychotherapy Ltd, for all services rendered. I understand all monies are due on or before each session unless other arrangements have been made in writing. I understand that all pre- paid sessions must be used within 180 days of today’s date.
I agree to all the terms listed above:
Clients Signature___________________________
Date_____________
Guardians signature (if client is a minor)__________________________________
Date_________________________
Disclosure Statement
CONFIDENTIALITY
Matters regarding your sessions will be kept confidential except in the following circumstances:
You grant me specific permission to release information to a specific individual or agency; in the case of child abuse; you are an imminent danger to self or others; or in the case of the subpoena of records. Any information shared is kept confidential. From time to time, I also consult with other colleagues, but in this circumstance, clients are not identified by name. Your signature below constitutes you giving permission for such consultations.
CANCELLATIONS
Since I have reserved our appointment time for you, it is my policy to charge for cancellations received less than 24 hours notice unless we are able to reschedule the appointment within the same week.
REPORTS AND PHONE CALLS
There is no charge for brief calls. Calls lasting longer than 5 minutes will be charged to the client on a prorated basis.
Reports requested by insurance companies, physicians, etc. will not be released without your permission.
I agree to all the terms listed above:
Client’s signature ____________________________________________________
Date __________
Guardian’s signature (if client is a minor) __________________________________
Date__________
Acceptance Of Terms
I, the undersigned, understand all questions and verify that all information is complete and accurate to the best of my knowledge. I also understand that the counselling therapy methods used by therapist Gregory May are not a substitute for medical or psychiatric treatment.
I understand these methods to be a collaborative process whereby an individual is taught to use their own abilities for their benefit and wellbeing. With this understanding, I hereby grant the therapist Gregory May permission to counsel me or the minor child whose name appears at the top of this form. I (we) further grant permission for the sessions to be recorded/taped as needed.
I know my progress is dependent upon my efforts and that there are no guarantees as to the result or progress to be made. I understand that the success of the treatment will be in direct proportion to my commitment to the end result.
I (we) agree to pay for services rendered to the above named client as the charge is incurred.
By signing this document, I am confirming that all information is true to the best of my knowledge, and I agree to all the terms listed above:
Client’s signature ____________________________________________________
Date __________
Guardian’s signature (if client is a minor) ______________________________
Date__________________
WHAT THE CLIENT CAN EXPECT From AIP Axiom Integrative Psychotherapy
Code Of Ethics
As a member of the National Counselling And Psychotherapy Society and the British Association Of Counselling And Psychotherapy I adhere to the fundamental principals under these codes of ethical conduct.
•Working towards the good of clients and doing no harm ( Beneficence and Non – maleficence)
•Being trustworthy and responsible ( Fidelity).
•Respect for the dignity and rights of the client (Autonomy).
•Practitioners are aware of their own judgements based on their own experiences ( Justice ) .
•Practitioners work to be as honest truthful and accurate as possible. They are also responsible for looking after their own needs and health. ( Integrity and self-responsibility )
•You should expect me to explain anything you do not understand clearly, and to answer any and all questions with patience and understanding.
Please see the following links for a full description:
National Counselling Society Code Of Ethics
bacp.co.uk Ethical Framework
Although I do not diagnose nor prescribe or tell people what to do, in the course of our sessions, I suggest, educate, motivate and inspire people to get well. I do not provide physical therapy.
I am not a doctor. Any suggestions or advice are general and should not be interpreted as a substitute for consulting with medical professionals. Accordingly, I take no responsibility for the consequences of any actions you might decide to take based on any comments or opinions I may express in the course of your visit.
CONFIDENTIALITY
I will not release any information to anyone without a written authorisation from you, except as provided for by law.
Data Protection
Under the terms of the GDPR Data Protection Act 2018
All Files on you kept in paper format will be stored in locked cabinets.
Any Electronic Files will be stored securely in a password encrypted format.
Your private data will remain private.
Client Name__________________________________________________________________
Client signature______________________________________________________________
Date___________________________________