Contract of Counselling

Your Details

First Name *

Surname *

Postcode? *

House/Flat Number *

Your Counsellor

Select Your Contract? *

Date

Privately Paid Contract

Contract

Sessions will take place at the agreed time and date which is pre-arranged between You and the Counsellor.

Drug/Alcohol use 
You will abstain from using any non-prescribed drugs, and alcohol on the day of the prior agreed counselling appointment. The counsellor will terminate the session if the patient is using Drugs or Alcohol on the day of the session. The session is considered lost and payment is still expected. 

Confidentiality 
All the sessions are confidential between You & the Counsellor. 

There are some limits to confidentiality:
• The clinical service manager has access to all clinical records.
• Counsellors/Psychotherapists regularly present their work in clinical supervision. The aim of this is to monitor and improve the clinical work undertaken. All supervision is done on a confidential basis and only using the client’s first name. 
• All DisabilityPlus practitioners work with a medical cover. They may at times need to contact your GP or other professional involved. This would normally be done with your permission and would be discussed in the session prior to any contact. However, if your or another person’s safety is severely jeopardised the practitioner may contact the external services without prior discussion.
• There are some legal limits to confidentiality such as the Prevention of Terrorism and Drug Trafficking Acts. 
• If you meet the counsellor unintentionally at a social event, You have permission to greet the counsellor, the counsellor will not approach You.

Confidential Record Keeping (Data Protection)
DisabilityPlus keeps session case notes to a minimum. 
The information recorded includes:
● Your name, date of birth, address and GP details
● Information that relates to the counselling process
● Confidential case notes, describing the main focus of the session and any other important information

Disclosure

In exceptional circumstances when DisabilityPlus believe there is a risk to your well-being, health or safety, or that of others (e.g., suicide, murder). At such times DisabilityPlus will not need your permission to pass on essential information to the relevant person(s) (e.g., police, your GP).

Sessions?

The first session is an introduction session paid at the reduced session fees. If your first session follows an assessment session for NHS funding there will be no introduction session. 

If you have purchased the pay-as-you-go plan it is 1 session at 50 minutes. and is paid in advance of the session.

If you have purchased a saver3, this is 3 sessions paid in advance of the first session. Each session is 50 minutes long.

Saver 3 Agreement

The Saver 3 session fees are discounted by £10 per session, this enables to counselling more affordable therefore fees are not refundable.

Payment Policy

Fees will be paid before the first session commences in full at the agreed amount. (in exceptional circumstances DisabilityPlus can agree to a stepped payment method)

If you wish to stop counselling before the end of the treatment plan of 3 sessions, there will be no return of fees on outstanding sessions.

Cancellation Policy

If you cancel the session with less than 48 hours’ notice of the appointment time, or if you are not available for the session at the agreed time, the funded session will be lost from the total number of sessions paid

NHS Funded Counselling

NHS Funded Contract

Sessions will take place at the agreed time and date which is pre-arranged between Counsellor & Client.

Drug/Alcohol use 
The client will abstain from using any non-prescribed drugs, and alcohol on the day of the prior agreed counselling appointment. The counsellor will end the session if the patient is using Drugs or Alcohol on the day of the session.

Confidentiality 
All the sessions are confidential between the counsellor and the client.
 
There are some limits to confidentiality:
• The clinical service manager has access to all clinical records 
• Counsellors/Psychotherapists regularly present their work in clinical supervision. The aim of this is to monitor and improve the clinical work undertaken. All supervision is done on a confidential basis and only using the client’s first name. 
• All D4D practitioners work with a medical cover. They may at times need to contact your GP or other professional involved. This would normally be done with your permission and would be discussed in the session prior to any contact. However, if yours or another person’s safety is severely jeopardised the practitioner may contact the external services without the prior discussion.
• There are some legal limits to confidentiality such as Prevention of Terrorism and Drug Trafficking Acts. 
• If the patient meets the counsellor unintentionally at a social event, the patient has permission to greet the counsellor, the counsellor will not approach the patient.

Confidential Record Keeping
Deaf4Deaf keep session case notes to a minimum. 
The information recorded includes:
●  Patient name, date of birth, address and GP details
●  Information that  relates to the counselling process
●  Confidential case notes, describing the main focus of the session and any other important information

Disclosure

In exceptional circumstances when Deaf4Deaf believe there is risk to your well-being, health or safety, or that of others (e.g., suicide, murder). At such times I will not need your permission to pass on essential information to the relevant person(s) (e.g., police, your GP).

Length of each session?

Each Counselling session is for 50 minutes in duration.

Application for Further Sessions

The NHS has awarded a set number of sessions for the client, the NHS will not guarantee any further sessions awarded after the initial total number of sessions awarded. If there is a requirement for further sessions Deaf4Deaf will apply for the number of sessions recommended by the counsellor. The NHS will deliberate over the application and decide if there is any further funding agreed.

NHS Further Session Funding Confirmation

A further set of funding is AGREED or DECLINED by the NHS, Deaf4Deaf do not Guarantee further funding will be agreed.

The Timescale for Further Funding Application

The NHS DO NOT GUARANTEE to make a decision on the client’s case within any set number of weeks of receiving further application for funding.

NHS Cancellation Policy

If a client cancels the session with less than 48 hours notice of the appointment time, or if the patient is not available for the session at the agreed time, the funded session will be lost from the total number of sessions awarded.
If the client misses two consecutive sessions without prior notice, the patients funding will be sent back to the NHS as per their policies.

How Many Counselling Sessions have you been awarded? * How Many Counselling Sessions have you been awarded?

Cost to Client?

There is no cost to the client for sessions funded by the NHS

Declaration NHS

Contract Confirmation Statement

I have read the Terms & Conditions of the Deaf4Deaf NHS paid counselling contract. I agree with its contents and with my signature, I agree to its terms and conditions.

Signature

Clear

Declaration Privately Paid