Sally Cloke Counselling
Couples Counselling Questionnaire
The General Data Protection Regulation takes effect on 25th May 2018
Please take your time to read through the information outlined. I do require your consent at the bottom of this document for our working together to continue.
This policy will explain how I use, maintain, and disclose your personal information. This policy applies to my practice, website, and services which I offer, both online by telephone and within my private practice.
What personal information I collect and why:
- Date of birth and age
- Email address
- Phone number
- GP’s name and contact details
- Childhood overview
- Details of support network
- Emergency contact information
- Counselling history
- Your hopes for counselling
Your personal information is used to help me to gain a better understanding of you and for safeguarding. When staying in contact there may be times during our working together, when we may require several methods of contact. This may be in the case of an emergency or at a time of the significant risk of harm to your self. Your GP/ Emergency details are therefore important to be held. Session notes are kept to help me to identify themes and inform our ongoing work.
How I store your information:
Brief notes following a session and personal details are kept in a secure cloud device called WriteUpp.
My smartphone is locked and password protected.
Emails are stored on my laptop and are username and password protected.
My website does not contain any personal details, however, should an inquiry come from this source it translates through to an email in my inbox.
Third-party websites may contain content that links, however, I am not responsible in how they collect, store or use information
- Client Information Request Form (where personal information is gathered)
- Privacy statement, which is signed by the client
- Client code
- Client session notes kept for 7 years in line with Insurance policy
What does confidentiality and information sharing mean?
All of the client information I gather will not be shared with anyone else. However, there are exceptions.
- My supervisor also holds your first name and contact number, which is in case of an emergency, such as a health crisis or if I die. You will then be contacted and informed of the situation.
- Emergencies: If I had serious concerns regarding the safety of yourself or others I would in the first instance contact my supervisor. Or if felt appropriate your GP / police
- If you disclose an act of terrorism or laundering of money, I am required to disclose information to the police
- If I am called upon by law to share any information
I will like to add that electronic communication is not necessarily secure, so please consider what sensitive information you share through these means. Although I strive to do my best, I cannot guarantee confidentiality.
Erasing your information
All inquiries made electronically will be erased after 3 months have passed.
All texts and contact numbers will be erased 3 months after therapy has come to an end.
Any written information I have will be kept for 7 years following our work coming to an end. This will be a reference should we work together again.
Your Rights under the general data protection regulation:
To Access: You have a right to request a copy of your personal information. This can be a paper copy or electronically free of charge. You also have a right to ask me to amend any information, which is incorrect.
To be forgotten: You have a right to ask me to erase information I may hold of yours. I would require this request in writing, please. This includes no longer relevant or you may choose to withdraw your consent. I am however obligated to do this unless; I have a legal obligation to retain the information or to remain in line with my insurance policy.
Data Portability: You have the right to receive your personal information and the right for it to be transferred to another party. To adhere to the GDPR the ‘data’ controller is Sally, at Sally Cloke Counselling.
Accessing your data:
To be able to access your data please request in writing, I will then ask that you sign a disclosure consent form. You will receive the information within 30 days of receipt of your request.
I give informed consent for Sally Cloke, at Sally Cloke Counselling and other professionals mentioned in this document to use my data in the way described within this document.
I acknowledge that I have received a copy of this privacy statement for my records and will refer to it for future reference.
My Terms and Conditions
Please find my contract, which contains important information and outlines how we are going to work together.
The contract is between…………………………………………………………………and Sally Cloke
Agreeing to work together means that we have contracted to meet for a counselling session. The length of the session will be decided upon, either a fifty-minute or one hour in duration. An extended session can be provided if pre-arranged. Sessions can be arranged either on a regular or ad-hoc basis, in a safe setting, which will enable you to explore any difficulties you may wish to discuss.
My role is to facilitate your process and be alongside you to help you move towards change if appropriate.
Anything you choose to say to me within the sessions remains confidential with the following exceptions:
I may sometimes feel it would be beneficial to discuss your sessions with my supervisor, or with other professional colleagues. These will be in confidence, with the aim for me to be more effective in our work together.
Danger to self or others
If you give me information that leads me to believe yourself or others are in danger, I may take further steps. Wherever possible I would discuss this with you.
Confidentiality will be suspended if there is a disclosure of an Act of Terrorism, Laundering of money, or for Legal reasons.
Internet or electronic communications
Nothing sent by e-mail or electronic equipment is completely safe, so please be aware of this if you contact me via, for example, e-mail, mobile phone, or Skype. I rarely accept (or send) invitations to social media sites, so please be aware of this.
Cancellations/ lateness and Missed Appointments
Our working contract ensures that your appointment is secured solely for you whilst we are working together. If you cancel less than 24 hours before your appointment or do not show for a scheduled appointment, you will be charged the full fee for that session.
Code of Ethics and Practice
I am a registered member of the British Association of Counsellors and Psychotherapists (BACP). This is my governing body to which ensures I adhere to ethical working practices and to protect you from malpractice. Please look at their website at www.bacp.co.uk
Contact between sessions
This is normally kept to short messages relating to practical issues such as timings/arranging appointments. My phone number is: 07743 401350 alternatively please email me using: email@example.com
Normally, I take brief notes after each session. This allows me to reflect on the work we have done together.
Fees and Payment
Individual counselling fees £60 one hour or £50 per 50-minute session.
Payment is kindly requested at the end of each session either by cash, personal cheque or by bank transfer before the appointment.
Sally Cloke: Sort code 111491 Account number 10010863
From time to time I may increase the fee. I will give you at least 4 weeks’ notice before-hand.
Once we have agreed to work together, unless we have agreed to a fixed number of sessions, my commitment to you is open-ended. When you are ready to stop, I ask for at least one session’s notice, so that we both have time to reflect on how best to end our time together.
Coronavirus is such a threat and therefore if I am tested and found to have a positive result, I will be contacted by the NHS test and trace service. I will be asked who I have been in contact with and may need to share your name and contact details with the NHS.