Common Contracts
1 similar Client/Therapist Agreement contracts
ContractClient/Therapist Agreement • June 9th, 2024
Select Healthy Mind Psychotherapy WINDSOR & ETON PRACTICECLIENT/THERAPIST AGREEMENT – BARBARA PACZKOWSKASelect Healthy Mind Ltdwebsite. selecthealthymind.co.uk Sun Close,Office email (admin) selecthealthymind@gmail.com Eton (Windsor),telephone 07514071824 (Barbara Paczkowska) Berkshire,Barbara Paczkowska (Clinical Director – Select Healthy Mind Ltd) SL4 6AREMDR UK & Europe Consultant/Supervisor & BABCP accredited CBT Psychotherapist *If you have any queries, please contact Select Healthy Mind using the contact details above. *IMPORTANT - Please complete all sections below and return this form to us BEFORE your initial assessment/first session:(you can request a pdf copy of your completed document via email at no charge) Client Name: Date of Birth: Home Address: Contact Number: Email address: Current G.P. (Name & Address) Please list any medication/prescription drugs currently taking and/or medical conditions that may affect your treatment: G.P./Surgery telephone number(if
