Initial Consultation Form

Where did you hear about me? Do you suffer with any of the following health problems: AlcoholismAsthmaCancerDiabetesHeart ProblemsHepatitisHigh blood pressureMental healthOsteoporosisEpilepsyStrokes Are you taking any medication at the moment?
If any of it feels relevant to share, please list it below How is your current state of health: Any operations in the last year or any pending? YesNo Stress Level 1 – 10 (10 being very high): 12345678910 Emotional and psychological state of mind 1 – 10 (10 being not well): 12345678910 Physical well being 1 – 10 (10 being very poor): 12345678910 Physical activities: exercise / mobility: Reason for treatment and therapeutic goals? Anything else you would like to add:

CLIENT AGREEMENT

Please read carefully. This agreement outlines how we will work together to ensure therapy is safe, effective, and supportive.

WORKING METHODS

My work is always integrative, combining person-centred and psychodynamic approaches as appropriate to support your needs. I may also draw on methods from somatic work, inner child work, visualization, shadow work, Reiki, or other therapeutic techniques where agreed. Some methods, such as Reiki, are complementary rather than clinical interventions. You may request or decline any method at any time.

WHAT I CAN DO AS A COUNSELLOR

I provide a safe, confidential space to explore your thoughts, feelings, and experiences. I support emotional processing, self-awareness, and personal growth, and help you understand patterns in your thinking, behaviour, and relationships. Together, we can set goals, review progress, and explore strategies to support your well-being.

COUNSELLING LIMITATIONS

I am a counsellor, not a doctor or psychiatrist. I do not diagnose or treat severe mental health issues or physical illnesses. If you have these, please seek support from your GP or other appropriate services. However, we can explore any psychosomatic or emotional issues related to physical illness and how the illness affects you. If at any point your needs fall outside my expertise, I may suggest a referral to an appropriate professional.

COMMITMENT TO THERAPY

By signing, you agree to engage in therapy to the best of your ability. We will review progress after four or more sessions. Therapy can feel challenging at times. If, after a few months, you feel it is not helping, please let me know so we can explore alternatives.

LENGTH OF THERAPY

Some clients need only a few sessions, while others may benefit from longer-term work. We will progress at a pace that suits your needs.

SESSION FEES

Standard sessions are £55–£75 per session on a sliding scale, payable on the day unless agreed otherwise.
A 90-minute session is available for an additional £25. This longer session is usually recommended for somatic or energy work, allowing enough time for these approaches to be effective and for you to fully integrate the experience.

Joint / family and couples sessions are 90 minutes, which allows enough time for everyone’s voice to be heard. The fee for a joint session is £75–£95 also on a sliding scale, and any changes to session length or format are always discussed and agreed in advance.

DEPOSIT

A non-refundable deposit of £35 is required to secure your first session. This deposit confirms your booking and will be applied toward the session fee. It is non-refundable because it also acts as the cancellation fee in the event of a late cancellation or a no-show. If you rearrange the session with more than 35 hours’ notice, the deposit can be transferred to the new appointment. If you choose not to go ahead with therapy, the deposit remains non-refundable.

SESSION TIMES, BOUNDARIES, AND CONTACT

Sessions start and end at the agreed time. If you arrive late, the session will still finish at the scheduled time, and I will not be able to make up the lost time.

Contact between sessions is for practical matters only (booking, rescheduling, or brief clarifications). You can reach me via WhatsApp, email, or text. I will respond during my normal working hours 8 am to 9 pm. Therapeutic support takes place within session time only. I will not respond to you via social media.

I will text to remind you of your session date and time; however, I may not always do this, so please keep note of your day and time.

If a session becomes available due to another client cancelling, I may send a message to relevant clients to see if they would like to take that slot.

FOLLOW-UP BETWEEN SESSIONS

If needed, you may have up to 15 minutes of follow-up contact via phone between sessions, free of charge, when my schedule allows. This time can be used for reflection or to discuss anything that feels unresolved or arises from a previous session, and is limited to once between sessions. If additional time is needed, it can be arranged at a fee of £15 per 15 minutes thereafter.

SESSION-RELATED INFORMATION

Occasionally I may share relevant articles, links, or resources that relate to your therapy work. This is done in a way that maintains confidentiality and is intended to support your progress between sessions.

CANCELLATIONS

Cancellations with less than 35 hours' notice, or missed sessions, incur a £35 fee.

ONLINE SESSIONS

Ensure a private, quiet space with a stable internet connection. If technical issues arise, we will attempt to reconnect or reschedule.

EMERGENCIES

I do not provide crisis support. If you are in danger or at risk of harm, contact emergency services, your GP, NHS 111, Samaritans, or your local crisis team.

CONFIDENTIALITY

Everything shared is confidential unless:

• There is immediate risk of harm
• A child or vulnerable adult is at risk
• Legal requirements demand disclosure

Where possible, I will discuss this with you first.

SUPERVISION

I attend regular supervision to ensure safe, ethical practice. Your identity is kept confidential.

RECORD KEEPING AND GDPR

Along with the initial consultation form, I keep brief notes to support your therapy, using only your first name. All notes and information are stored securely in line with GDPR 2018, retained for the required period, and then securely destroyed. They are used solely to support your therapy and may be discussed in supervision or shared if legally required.

ENDING THERAPY

You may end therapy at any time. When possible, we plan endings together. I may suggest ending or referral if therapy is no longer appropriate.

AGREEMENT

I have read and understood this agreement and consent to the terms.