Dear Client,
This form has been prepared to provide you with information about the psychological services you will receive, explain your rights, and outline the general principles and boundaries of the therapy process. This form ensures that clients are informed, promoting a safe and ethical therapeutic process. The following information sets out the principles and conditions of the professional relationship that will be established between you and your Psychologist/Therapist. Please read the form carefully and do not hesitate to consult your Psychologist/Therapist if you have any questions.
Basic Terms and Conditions
Any session (insured or uninsured/private) cancelled or rescheduled by the Client with less than 48 hours’ notice, will be charged in full to the Client, unless the sessions are taken up by other Clients.
All appointments for uninsured Clients/private paying Clients must be paid for in full 48 hours before the scheduled session. Failure to do so will result in you losing the session.
Clients covered via personal injury / litigation, may lose the session from the authorised number of sessions.
Clients covered by Insurance (e.g. BUPA, WPA) are liable for any missed appointments/cancellations and will be charged the full session amount directly.
If payment is via insurance, it is the Client’s responsibility to ensure that their insurance is valid. Clients are ultimately responsible for payment of sessions. If insurance companies do not provide payment, the Client is liable for this. Clients are responsible for checking the amount of insurance excess they are required to make and are responsible for payment of this.
The Psychologist/Therapist abides by codes of confidentiality and privacy. For more information see our privacy statement.
Your Psychologist/Therapist may only be reached for the purposes of cancellations and rearrangements with regards to your appointment sessions. We are sorry, but it isn’t possible to provide support in between sessions.
Detailed Terms and Conditions
1) Privacy, Confidentiality, and Record Keeping
Everything discussed during the sessions remains confidential between the Client(s) and the Psychologist/Therapist and will not be shared with third parties. This includes refraining from sharing the content of sessions with children and young people with their parents/carers without explicit permission from the children and young people. Please refer to our Privacy Policy for more information.
2) Principle of Non-Maleficence
Your Psychologist/Therapist is committed to ensuring that you do not experience any physical, emotional, or psychological harm during sessions. The aim is to support you and improve your quality of life. If you ever feel uncomfortable in any situation, please inform your Psychologist/Therapist.
3) Principle of Equality and Justice
Your Psychologist/Therapist strives to maintain an equal and fair approach at all times. Services are provided impartially and respectfully, considering differences such as race, gender, gender identity, religion, culture, language, and social status.
4) Professional Boundaries
The relationship between you and your Psychologist/Therapist must remain strictly professional. Emotional, romantic, or commercial relationships would breach these boundaries and violate ethical principles. Our relationship will be limited to the therapeutic process. If your Psychologist/Therapists sees you outside of the therapy premises, they will not initiate conversation with you and aim to not give any indication to recognise you to respect your privacy.
5) Professional Competence and Continuous Development
Your Psychologist/Therapist is a trained and competent professional or is currently undergoing professional training. To provide you with the best possible service, they continuously engage in professional development, stay informed about scientific research, and seek supervision to support their practice. To do so, the Psychologist/Therapist may require to share some of the information you provide anonymously in supervision. Please see Privacy Policy for details.
6) Cultural Sensitivity
Your Psychologist/Therapist is aware of cultural and social differences and respects them. They work with cultural sensitivity in mind, acknowledging and responding to each individual’s unique needs.
7) Legal Compliance
Your Psychologist/Therapist operates in accordance with the professional and ethical guidelines for Psychologist/Therapists in the United Kingdom. Ethical standards set by the HealthCare Professions Council (HCPC) and British Psychological Society (BPS). These terms and conditions are governed by and to be interpreted in accordance with English law. In the event of any disputes regarding the terms and conditions of this document or any matters related to the Psychologist/Therapist, the English courts of will have non-exclusive jurisdiction over such dispute.
8) Client Rights
Confidentiality & Exceptions: Your personal information is protected and will not be shared without your consent as detailed in the Privacy Policy.
Access to Information: You have the right to receive clear and transparent information about the therapy process. Any written information requests are handled within the terms and conditions detailed in the Privacy Policy.
Professional Service: You are entitled to receive services at the highest professional standards.
Complaints and Feedback: You may express any dissatisfaction or concerns at any stage of therapy.
9) Client Responsibilities
Communicating openly with your Psychologist/Therapist and sharing any important information that may affect the process.
Respecting the ethical boundaries of therapy.
Attending sessions regularly and on time.
10) Appointments, Fees, Cancellation, No-Show, and Premature Termination
A therapy session last 50 minutes and cost is varied based on the credentials of your clinician and whether your sessions are being funded and paid for by you or an official third party such as your insurer or solicitor. You can find the most up-do-date rates on the website, as well as at the end of this document.
A request for a psychological letter written to your employer, university/school, GP or other person via email or post, is priced at our basic hourly rate. If the official third party who is funding your sessions do not fund reports, you will be responsible with the payment.
You need to cancel any scheduled appointments with 48 hours’ notice. If you cancel within this time, you must pay for the missed session in full. The Psychologist/Therapist may attempt to fill your vacant slot. If we are able to fill this slot, we will refund this session. However, this is not always possible and the Psychologist/Therapist is under no obligation to try and fill this slot.
If payment is not received, we will assume you no longer wish to attend your scheduled appointment and may cancel it or offer the slot to another Client. To reschedule, you will need to rebook, and any outstanding payments must be settled in full before booking another session. Repeated cancellations, even those made outside the 48-hour notice period, may lead to your Psychologist/Therapist determining that no further appointments can be offered.
Your Psychologist/Therapist is entitled to terminate your session without a refund if they feel you are a personal risk to them or anyone in the immediate environment. The appropriate services will also be alerted in all cases of violence or personal threats. Vandalism, personal threats, verbal abuse or physical abuse is not tolerated and the session will be cancelled with immediate effect without refund. The Psychologist/Therapist reserves the right to protect the interests of the business and their personal safety and will terminate the session with the Client if the business is compromised by the Client in any way, without refund to the Client.
11) Payments
All payments are done by bank transfer using your name as a reference. The bank details will be shared with you and will be detailed at the end of this document.
Contact us for details on how to make alternative payment arrangements if bank transfer is not possible.
12) Attending Appointments
You are paying for the agreed time slot with your Psychologist/Therapist. Getting to the session location and arriving on time and/or attending the session from a confidential space using a secure connection if you are attending remotely is your responsibility.
If you are late, we are not able to offer an extension of the time agreed and you will be able to use the remaining time. If you are over 15 minutes late for an appointment, we will try to contact you using any details we have. If you are over 30 minutes late for an appointment and we have been unable to contact you, we will assume that you are unable to make it and the session will be terminated. Full fees will apply in these circumstances. In order to make sure we are not late for our other Clients; your Psychologist/Therapist will not go beyond the arranged end of session time for any reason.
13) Other Conditions
Your Psychologist/Therapist will use reasonable care and skill in providing the service that you choose. Every Client is different and there are no guarantees of successful results. For psychological input to be effective, it is important that you take full responsibility for achieving your goals with the help of the Psychologist/Therapist. By engaging with us, we assume that all information you have given us is accurate from your perspective. In the small percentage of people that feel their input has been unsuccessful, we do not offer a refund or part refund. The Psychologist/Therapist do not accept any liability in relation to the therapy and modalities used in session.
You are not permitted to record the session on the phone or otherwise unless you have written consent by the Psychologist/Therapist. All therapy and advice given is for your individual use. The Psychologist/Therapist takes no responsibility for the impact the materials discussed in sessions might have on any other person.
For more details on how we use your data, check out our privacy policy.
Consent and Acknowledgement
I have read, understood, and accepted the principles and rights stated above. I acknowledge that I will receive services within the framework of these rules throughout my therapy.
Client Session Fee (may be subject to increase):
£_____ per 50 minute session with ____________________________________ (Psychologist/Therapist)
Bank Details for Payment:
Name: _______________________________ Sort Code: ____-____-____
Account Number: ________________
Client Name-Surname: ____________________________________
Signature: _________________________ Date: ___/___/_____