This statement confirms how I, Sian Grange (member of BACP), use and protect any information that you give to me whilst using this service.
I am committed to safeguarding and protecting your information. If I ask you for any information it will only be used according to this privacy statement.
I may change this policy from time to time in line with the legislation and whilst we are still working together I will provide you with a copy of any change.
Information I Collect
I store your name, telephone number and email address and other personal
information that you provide to me. I will also keep brief handwritten notes recording the themes of our
How I Store Information
All information kept with your personal details on are stored in a locked filing cabinet and destroyed 5 years after your counselling sessions end unless agreed otherwise. Handwritten session notes are kept securely separately. Any emails, texts, whatsapp messages or other communications will be deleted at any time but not later than one month after we have finished our work unless they form part of your notes or are needed for income tax purposes in which case they will be kept for 5 years as above.
Your telephone number will be stored on my mobile phone under your initials or your first name only until your session’s end at which point it will be deleted. At the end of these periods respectively I will confidentially shred or burn all paper copies. In the case of clients under 18, records are kept for 5 years after the child turns 18.
How I use this Information
I will use your contact details to engage in my work with you according to my contract with you. This will include details about appointments, keeping records, running and maintaining my business. I also keep brief notes of counselling sessions in order to support me in offering you counselling. I will not use contact information or your session notes for any other purpose other than in this notice and my contract. If for any reason I am asked to provide a report of the sessions – e.g. at your request, then this will be sent to you, providing I can talk with you in person beforehand. This information will also be stored for 5 years and kept securely.
Your Rights and Access to Information
You, the client have the right to ask to see any information that I hold about you. This is facilitated by a formal request from you, as my notes are handwritten, I am happy to look at this in a booked session with you. You have the right to ask me to change or delete any information that I hold that is incorrect. I will do this except for any information that I need to hold for legal purposes such as business tax and insurance purposes.
All records will be kept securely and confidentially. I will take all reasonable precautions prevent the loss, misuse or alteration of information you give me.
This contract expresses the commitment each of us makes at the outset and to clarify how I practice and to set out the terms under which I work so that they are clear. This contract is subject to re-negotiation at any stage of the working relationship by both parties, if at any time you have any concern or query please let me know as soon as possible.
Following our initial assessment we would agree how long to work together. On the sixth session we will review our work together and discuss our current working contract with a view to either extending or ending our counselling sessions. For effective therapy we endeavor to maintain a regular and continuous commitment. Our sessions can either be online via zoom or face to face and will be for an hour.
The fee per session is currently £45 to be paid for at the time, or in advance, either cash or BACS
The session needs to begin at the agreed time, any session beginning after this time; due to your late arrival, cannot be extended beyond the original finish time.
If you need to cancel a session please give me a minimum of 24 hours’ notice. If less than 24 hours’ notice is given then I will still charge you for the session, unless for exceptional circumstances. If for any reason I have to cancel a session due to illness or other unforeseen circumstances I will endeavor to also give you 24 hours’ notice.
We will agree on holiday leave arrangements together.
As a member of the BACP, British Association of Counsellors and Psychotherapist (bacp.co.uk) I am bound by its code of ethics, good practice and subject to its complaints procedure. I am committed to providing a safe therapeutic environment where all our work together is confidential; I will not disclose any information about you to a third party without your consent subject to the following exceptions.
If, in extreme circumstance, I believe you or someone else is at serious risk.
Some laws in certain circumstances require me to break confidentiality, such as the Terrorism Act and Drug Trafficking Act. In certain circumstances I am required by law to break confidentiality without informing you.
For the purpose of my supervision, an ethical responsibility to ensure I am working in a safe and effective manner
I would endeavor wherever possible to inform you in advance.
My records are limited to any information you give me regarding your contact details, medication and contact with other professionals, a brief history and a record of sessions attended, missed or cancelled. To help me monitor I keep brief notes recording the themes of the counselling session. All records are securely stored according to the data protection act, and are kept for 5 years then destroyed.
You will have been given a privacy notice with this contract. This sets how I manage and safeguard your data. Please read this carefully, I will regularly update this if so required. If you have any concerns about this then please discuss them with me.
You are of course free to end counselling at any time. However, in order to look at what has been achieved and bring the counselling process to an end I would appreciate if you could give me a session’s notice of your decision, or preferably we agree this together, in advance.
If we meet in public I will acknowledge you in a friendly manner unless you express the wish not to be acknowledged.
Your Contact details
GP’s name and address:
Emergency contact name and number:
Reason for Counselling:
What do you want from Counselling?
Please read this contract carefully, if you wish to negotiate changes I will be happy to do so before you sign. Please sign below to indicate that you have read and accepted the information above as well read and accepted the privacy notice, either send back electronically, bring a printed copy to your first session or reply to this email saying that you agree to it all. Thank you.
You can download a copy of this agreement to print, sign and return to me by clicking here.
Updated Informed Consent for Covid 19 and Face to Face Sessions
This document contains the information to be considered regarding face to face counselling and in light of the COVID-19 public health crisis. Please read this carefully and let me know if you have any questions.
This agreement supplements the therapeutic contract which was agreed to at the start of our work together.
Decision to Meet Face-to-Face
Even with Covid restrictions lifted I will be following some preventative guidelines to keep us all safe. If there is a resurgence of the pandemic and guideline and/or enforcements change or if other health concerns arise it may be required to revert to telephone or online work (Zoom). Please let me know if at any time you decide that you would feel safer going to online services, your wishes will be considered and we can discuss whether this would be therapeutically appropriate.
Risks of Opting for In-Person Services
By meeting face to face, you need to be aware that this does assume a higher risk of exposure to the coronavirus, as others will also be using this space.
Your Responsibility to Minimize Your Exposure
For face to face work you must agree to take certain precautions which will help keep everyone safe including yourself and if appropriate, me, our families and other clients.
Please do not attend if you have any coronavirus OR cold symptoms .
If you arrive early for your appointment then please wait in your car until the time arranged for your appointment.
Please use the provided alcohol-based hand sanitizer as you enter the building.
Please adhere to safe distancing precautions in the building.
Please keep a distance and avoid physical contact (e.g. shaking hands)
Please take steps between appointments to minimize your exposure to COVID-19.
If you have a job that exposes you to other people who are infected, please let me know.
If a resident of your home tests positive for the infection, please let me know immediately and if appropriate we can then transfer the therapy to telephone or online, (Zoom).
Please bring your own water and tissues.
Precautions above may change if additional local, county or government orders or guidelines are published. If that happens, I will contact you to talk about any necessary changes.
If You or I Are Sick
I am sure that we are both committed to keeping you, me, and all of our families safe from the spread of this virus. If you have a fever or other symptoms that may be coronavirus including general cold symptoms, or if I believe you have been exposed to Covd-19, I reserve the right to discontinue our scheduled face to face appointment with a view to following up with services online if appropriate.
If I test positive for the coronavirus, I will notify you so that you can take appropriate precautions.
Your Confidentiality in the Case of Infection
If you have tested positive for the coronavirus, I may be required to notify local health authorities that you have been in my premises. If I have to report this, I will only provide the minimum information necessary for their data collection and will not go into any details about the reason for our visits. By consenting to this form you are agreeing that I may do so.
My Commitment to Minimize Exposure and to provide a Covid secure environment
My practice has taken steps to reduce the risk of spreading the coronavirus. On my Premises I am taking the following precautions to protect clients and help slow the spread of the coronavirus.
I will ensure the therapy room has enough ventilation - the window will be left open to allow air flow – please wear appropriate warm clothing if necessary, the heating will be on and clean blankets/throws are available.
I will maintain safe distancing.
Hand sanitizer will be available in the cabin.
I will schedule appointments at specific intervals so there is never client overlap.
I will ask that all clients wait in their cars and do not come to the cabin until their agreed appointment time.
Any items and areas that are commonly touched will be thoroughly sanitized after each use.
Tissues and rubbish bins will be easily accessed. Rubbish will be disposed of on a frequent basis.
Common areas including door handles and light switches will be disinfected at the end of each client session.
Additional informed consent for face to face work
Sessions will take place in my summer house which is across the lawn. Please be aware that there may be uneven surfaces around the garden and there are different levels and steps to the summer house, let me know if you may require additional support. Due to weather conditions there may be mud and the surfaces may be slightly slippery, please wear appropriate footwear if necessary.
Apologies but there are no toilet facilities available.
Please can I just remind all clients not to arrive to the property too early to allow others to come and go freely and to maintain confidentiality, you can wait down the hill in the village if necessary, and can I remind you all to please stay in your vehicle until the time of your appointment.
If you have any questions please don’t hesitate to ask.
Download Covid 19 Policy
Click HERE to download a copy of my Covid 19 policy.