Do Not Agree. If I am unable to attend, I will contact the service on 00000 000000 or 07538475987 to cancel the appointment giving as much notice as possible by speaking with the administration team or leaving a voicemail. I/we understand the cancellation /fail to attend policy points as above. Your appointments We will provide a safe, confidential, undisturbed and private environment to enable you to gain the most out of each appointment that you attend. Appointments are on average 50minutes in length. Whilst we aim to start appointments promptly, occasionally and only in exceptional circumstances might the start time be a little delayed. If you are more than 10minutes late to your appointment, it will be the therapist’s discretion as to the appointment going ahead on that occasion. If the appointment continues, it will be ended at the original booked appointment time. Any booked appointment that is cancelled due to late attendance will be counted toward one of the 8 allocated for your episode of care. The service operates from a base. ALL contact is to be made via the service office on 01254 283333 or 07538475987. Attendance: I/we agree to attend my appointments punctually so far as within my control to do so. Mobile phones: I/we agree to turn off mobile phones whilst in appointments Alcohol and substance: I/we agree not to attend appointments under the influence of alcohol or substances/drugs as this invalidates the session. Babies/children: I/we understand that it is inappropriate to attend therapy with children of any age. Agree Do Not Agree Animals: I/we understand that it is inappropriate to attend therapy with animals of any kind with the exception of assist dogs.
Do Not Agree. When a couple is the client, the notes made remain the confidential material of the couple relationship meaning that one person cannot request access without the permission of the other. I/we understand the information regarding access to records The therapeutic alliance We provide a non-judgemental professional environment and you will be treated at all times with respect and dignity Equally all staff in the team is entitled to be treated with due consideration and respect. The service has a right to end therapy if a perceived threat to the physical or psychological wellbeing of its staff is apparent. All therapists have a professional obligation to adhere to College of Sex and Relationship Therapists (COSRT) Code of Ethics and Practice for General and Accredited Members and the Conduct Procedure. All of which can be found on the website xxx.xxxxx.xxx.xx.
Do Not Agree. We are keen to ensure we provide a quality service. To receive your feedback we would like to send a brief text to you after each appointment I/we understand the information regarding the therapeutic alliance Agree Do Not Agree I/we agree to receiving this SMS after my/our appointments Agree Do Not Agree I/we give consent to commence therapy within SHARE-Psychosexual Service. I/we understand that commitment to therapy by myself and my therapist best places me/us to address difficulties however there is no guarantee of the outcome. .
Do Not Agree. I/we understand the information regarding the therapeutic alliance Agree Do Not Agree I/we give consent to commence therapy within SHARE-Psychosexual Service. I/we understand that commitment to therapy by myself and my therapist best places me/us to address difficulties however there is no guarantee of the outcome. PLEASE TURN OVER TO COMPLETE AND SIGN THIS AGREEMENT / CONTRACT Once signed and dated by client and therapist, one copy will be retained by the client and a second copy saved into your records Label Client/s/Therapist signatures Client 1 signature PB Number Date PBP Client 2 signature PBP Number Date Label Therapist signature Print name
Do Not Agree. The service will respect the clients preferred methods of contact. All contact with the service/therapist will be via the service office on 01254 283333 or 07538475987. Under no circumstance should the client attempt to contact their therapist by any other means including personal/business mobile numbers, email or on social media. I/we understand the restrictions to contact outside of my sessions Information Governance Your therapist will make notes on the sessions which are kept on an electronic database which is not available to your GP or hospital records. These clinical notes are only available to the SHARE Psychosexual Team. Information shared by you in your appointments is kept strictly confidential with the following exceptions: If your therapist has any concerns that you or someone else will come to significant harm, or in cases such as child protection or terrorism, we are bound by law to breach confidentiality and report accordingly. Periodically your therapist will discuss their entire caseload with a colleague in a process called clinical supervision. This will include your case, but this information is shared no further. Your therapist may also write letters that concern you and your case. The information in any correspondence is extremely considered, and only essential information shared which is not to the level of detail discussed in session. You will be routinely offered a copy of letters concerning your care. PLEASE INFORM THE TEAM OF ANY CHANGES TO YOUR ADDRESS, PHONE NUMBERS OR GP WHILST IN OUR CARE Records are kept as per TRUST policy before being appropriately archived, deleted or anonymised. Agree
Do Not Agree. If you attend therapy as a couple, all clinical notes in both your individual records will appertain to both parties and be identical. Further information regarding how we use health records will be discussed at your initial appointment and a leaflet given. I/we understand the information regarding record keeping and confidentiality agree to Inform the team of any changes to personal details ie address, phone numbers or GP Access to your records Discuss with your therapist if you wish to have access to your records whilst a client in the service. Once discharged from the service to access any health records you would need to complete a “subject access request” via the Data Access Team 01253 300000 (Trust switchboard number).
Do Not Agree. When a couple is the client, the notes made remain the confidential material of the couple relationship meaning that one person cannot request access without the permission of the other. I/we understand the information regarding access to records The therapeutic alliance We provide a non-judgemental professional environment and you will be treated at all times with respect and dignity Equally all staff in the team is entitled to be treated with due consideration and respect. The service has a right to end therapy if a perceived threat to the physical or psychological wellbeing of its staff is apparent. Agree Do Not Agree All therapists have a professional obligation to adhere to College of Sex and Relationship Therapists (COSRT) Code of Ethics and Practice for General and Accredited Members and the Conduct Procedure. All of which can be found on the website xxx.xxxxx.xxx.xx. I/we understand the information regarding the therapeutic alliance Agree Do Not Agree I/we give consent to commence therapy within SHARE-Psychosexual Service. I/we understand that commitment to therapy by myself and my therapist best places me/us to address difficulties however there is no guarantee of the outcome. . PLEASE TURN OVER TO SIGN THIS AGREEMENT / CONTRACT Once signed and dated by client and therapist, one copy will be retained by the client and a second copy saved into your records Client/s/Therapist signatures PB Client 1 signature PB Number Date PBP Client 2 signature PBP Number Date Therapist signature Print name Date
Do Not Agree. The service will respect the clients preferred methods of contact. All contact with the service/therapist will be via the service office on 01253 958020 or 07538475987. Under no circumstance should the client attempt to contact their therapist by any other means including personal/business mobile numbers, email or on social media. I/we understand the restrictions to contact outside of my sessions Information Governance/Confidentiality Your therapist will make notes on the sessions which are kept on an electronic database which is not available to your GP or hospital records. These clinical notes are only available to the SHARE Psychosexual Team. Information shared by you in your appointments is kept strictly confidential with the following exceptions: If your therapist has any concerns that you or someone else will come to significant harm, or in cases such as child protection or terrorism, we are bound by law to breach confidentiality and report accordingly. Periodically your therapist will discuss their caseload with psychosexual colleagues in a process called clinical supervision. This may include your case and maybe discussed in an individual or group setting, but this information is shared no further. Your therapist may also write letters that concern you and your case. The information in any correspondence is extremely considered, and only essential information shared which is not to the level of detail discussed in session. You will be routinely offered a copy of letters concerning your care. PLEASE INFORM THE TEAM OF ANY CHANGES TO YOUR ADDRESS, PHONE NUMBERS OR GP WHILST IN OUR CARE Records are kept as per TRUST policy before being appropriately archived, deleted or anonymised. If you attend therapy as a couple, all clinical notes in both your individual records will appertain to both parties and be identical. Agree Do Not Agree Further information regarding how we use health records will be discussed at your initial appointment and a leaflet given. I/we understand the information regarding record keeping and confidentiality agree to Inform the team of any changes to personal details i.e., address, phone numbers or GP Access to your records Discuss with your therapist if you wish to have access to your records whilst a client in the service Once discharged from the service to access any health records you would need to complete a “subject access request” via the Data Access Team 01253 300000 (Trust switchboard number). When a couple is the client,...
Do Not Agree. I/we understand the information regarding access to records The therapeutic alliance We provide a non-judgemental professional environment and you will be treated at all times with respect and dignity Equally all staff in the team is entitled to be treated with due consideration and respect. The service has a right to end therapy if a perceived threat to the physical or psychological wellbeing of its staff is apparent. All therapists have a professional obligation to adhere to College of Sex and Relationship Therapists (COSRT) Code of Ethics and Practice for General and Accredited Members and the Conduct Procedure. All of which can be found on the website xxx.xxxxx.xxx.xx. Agree
Do Not Agree. When a couple is the client, the notes made remain the confidential material of the couple relationship meaning that one person cannot request access without the permission of the other. I/we understand the information regarding access to records The therapeutic alliance We provide a non-judgemental professional environment and you will be treated at all times with respect and dignity Equally all staff in the team is entitled to be treated with due consideration and respect. The service has a right to end therapy if a perceived threat to the physical or psychological wellbeing of its staff is apparent. Agree Do Not Agree All therapists have a professional obligation to adhere to College of Sex and Relationship Therapists (COSRT) Code of Ethics and Practice for General and Accredited Members and the Conduct Procedure. All of which can be found on the website xxx.xxxxx.xxx.xx. I/we understand the information regarding the therapeutic alliance Agree Do Not Agree I/we give consent to commence therapy within SHARE-Psychosexual Service. I/we understand that commitment to therapy by myself and my therapist best places me/us to address difficulties however there is no guarantee of the outcome. .
