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                                                                                    Agreement for therapy


All material from our sessions is kept strictly confidential.

I may discuss my work with you with my supervisor (it is an ethical requirement for all psychotherapists to be in supervision), and my supervisor is also bound by this confidentiality.

If I felt concerned that you were at significant risk of causing harm to yourself or to another during the course of our work together, I might consider a need to break confidentiality. I would always talk to you about this before doing so.

Please attend the sessions on time. Sessions are fifty minutes. 

I have a 24 hour cancellation policy. If you cancel less than 24 hours before your session, I will have to charge for the session.


I am BPS and HCPC registered.

I abide by these organisations’ codes of ethics, complaint procedures and confidentiality policies, please see my website for links to them.

Please fill in your contact details below. 


Name:                  _________________________________

Surname:             _________________________________

Your address:     ______________________________________________________________________________________________________

Telephone:         _________________________________

Email:                 _________________________________

GP name:           _________________________________

GP surgery:        _________________________________

Your signature:  _________________________________

Date:                  _________________________________

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