Contract of counselling - DisabilityPlus

Your Details

Your First Name *

Your Surname *

Postcode? *

House/Flat Number *

Your Counsellor

Select Your Contract? *

NHS Funded

Saver3

Paid by Session

Employer Support

Sessions Approved?

Employee Support Program

Employer Support Session Contract

Sessions will occur at the agreed time and date, pre-arranged between Counsellor & Yourself.

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 end the session if you are using Drugs or Alcohol on the day of the session.

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 confidential and only use your first name. 

• All DisabilityPlus practitioners work with a medical cover. They may sometimes need to contact your GP or other professionals involved. This would usually be done with your permission and discussed in the session before 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
DisabilityPlus keep 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).

Cancellation Policy

If you cancel the pre-arranged session with less than 48 hours notice of the appointment time or are unavailable, the session will be lost from the total number of agreed sessions authorised.

Length of each session?

Each Counselling session is for 50 minutes in duration.

Cost?

There is no cost to the client for sessions funded by the Employee Assisted Company up to the number of sessions authorised.

Contract Confirmation Statement

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

Signature *

Clear

Saver3 Contract

Sessions will occur at the agreed time and date, pre-arranged between Counsellor & Yourself.

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 end the session if you are using Drugs or Alcohol on the day of the session.

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 confidential, and only use your first name. 

• All DisabilityPlus practitioners work with a medical cover. They may sometimes need to contact your GP or other professionals involved. This would usually be done with your permission and discussed in the session before 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
DisabilityPlus keep 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).

Saver3 is?

3 sessions paid in advance

Saver3 (NO REFUND) Agreement

The Saver3 session fees are discounted by £10 per session, this enables your counselling more affordable therefore fees are not refundable.

Payment Policy

Fees will be paid before the first session commences.

In exceptional circumstances DisabilityPlus can agree to a stepped payment method, this will be recorded by email and agreed by you by email. 

If you wish to stop counselling before the end of the the 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

Declaration Saver3

Contract Confirmation Statement

I have read the Terms & Conditions of the DisabilityPlus saver3 counselling contract. I agree with its contents and with my signature, I agree to its terms and conditions.

Signature

Clear

Paid-by-Session Contract

Sessions will occur at the agreed time and date, pre-arranged between Counsellor & Yourself.

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 end the session if you are using Drugs or Alcohol on the day of the session.

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 confidential, and only use your first name. 

• All DisabilityPlus practitioners work with a medical cover. They may sometimes need to contact your GP or other professionals involved. This would usually be done with your permission and discussed in the session before 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
DisabilityPlus keep 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).

Paid-by-session is?

1 x session paid in advance

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 session will be lost & payment is still required.

Declaration Paid by Session

Contract Confirmation Statement

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

Signature *

Clear

NHS Funded Contract

Sessions will occur at the agreed time and date, pre-arranged between Counsellor & Yourself.

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 end the session if you are using Drugs or Alcohol on the day of the session.

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 confidential, and only use your first name. 

• All DisabilityPlus practitioners work with a medical cover. They may sometimes need to contact your GP or other professionals involved. This would usually be done with your permission and discussed in the session before any contact. However, if your or another person’s safety is severely jeopardised, the practitioner may contact the external services without prior discussion.

• The NHS funding panel may require a report on your progress; this would typically be at the halfway stage of your total number of sessions & on completion of the contracted number of sessions.

• The report, as explained above, will also be passed to your GP.

• The report will be kept to your clinical improvements and not disclose personal information that may discriminate against you.

• 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
DisabilityPlus keep 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).

NHS funding is?

The allocated number of sessions authorised by the NHS, The total number of sessions allocated includes your assessment session. 
There is no financial cost to you for any session.
Example: 6 sessions approved, you will receive 5 sessions as the assessment sessions is deducted from the total number of 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 session will be lost from the total number of sessions approved.

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