
Patient Declaration
All patients are required to sign the following declaration in order to commence therapy and will have the opportunity to discuss it with the therapist during their initial consultation. Any person under the age of 18 wishing to receive therapy will require a parent/guardian to co-sign:​
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I understand the nature of the therapy and it has been explained to my satisfaction.
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I understand the probable duration of the therapy, or the estimated number of therapy sessions required for treatment. This has been explained to my satisfaction.
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I understand that “Homework” may be set to be completed between my therapy sessions. I understand that this is for my benefit and agree to complete all homework to the best of my ability.
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I understand that there is a fee for treatment and agree to pay this in the requested manner.
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I understand that there is a 24-hour cancellation policy and that deposits will not be refunded for any cancellations made within 24-hours of the appointment start time. I understand that this cancellation fee will be waived in the event of personal emergency and illness for up to 3 occurrences, provided that I contact the therapist within 7 days and reschedule the appointment.
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I have disclosed all information which might affect the outcome of treatment or my well-being, and confirm that I have not received a diagnosis of psychosis.
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I understand that GP consent is required prior to treatment for symptoms associated with severe medical conditions.
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I understand that I must reschedule any upcoming appointments should I suspect that I have COVID-19 symptoms. I understand that I will be able to reschedule free of charge and return to therapy once a medical test has indicated that I do not have the virus.
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I understand that a guarantee of a successful outcome is not possible and that the specific result may not be achieved due to circumstances outside of the therapist’s control.​
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I understand that the therapist has the right to terminate therapy at any point they deem necessary.
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I understand that any verbal or physical abuse towards the therapist will result in immediate termination of the therapy.
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I understand that I qualify to receive one psychotherapist statement/letter free of charge once I have attended a minimum of 3 therapeutic sessions. I understand that additional statements/letters may be requested for a small fee.
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I understand that all trance work will be recorded with an audio device for the purpose of documenting the therapy.
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I understand that my personal data will be collected for treatment purposes only and that this information is stored in accordance with the General Data Practice Regulations (GDPR).
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I understand that all information shared with the therapist is confidential and will only be shared with other healthcare professionals such as GPs and Clinical Supervisors if necessary. The therapist will inform me if this is necessary and ask me for my consent should they need to contact my GP.
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I understand that my therapy case file will be stored for 8 years after treatment has terminated in accordance with CNHC policy.