(in accordance with the General Data Protection Regulation GDPR 25.5.18).
This form contains information about Privacy Policy, Professional Services, Business Policy, Attendance and
Fees, Contact Details and Consent. Once you sign it, this document will represent an agreement between
us.
PRIVACY DETAILS POLICY
In my role as a therapist, it is a contractual necessity that I reference my role as a Healthcare Professional
working with safeguards (recognised by National Accreditation bodies within my profession i.e. BPS and
HCPC) in order to provide cover for holding and using sensitive data. This means you have the following
rights regarding the information I hold about you and are there to protect you. These rights are: access;
rectification; erasure; restrict processing; data portability; objection to automated decision making and
profiling.
I adhere to the following principles: All information is processed lawfully, fairly and in a transparent manner;
collected for legitimate purpose; only to collect necessary information; keeping information accurate and up
to date; retaining information only for as long as necessary (usually 6 years according to Statute of
Limitations and if under 18 from current age until 18 and then a further 6 years); and that information is
processed and kept securely.
Grounds for consent: This means you have been given clear consent for a specific purpose(s) of the use of
your information, which can be revoked at any time by you. To give consent to the fact that your information
is necessary for the performance of the contract you have entered into. That the consent is freely given by
you - is explicit/specific, informed and unambiguous.
The only people I will be sharing information with are insurance companies, who already hold information
about you i.e. name and address, date of birth, insurance membership number and presenting diagnosis and
upon request any potential update on your treatment.
Sessions are highly confidential and information would only be shared with third parties with your
permission. You may want your GP or other a person who has referred you to be kept informed about your
treatment. However all of this will be discussed with you and your wishes respected. The only exception to
sharing details about your treatment would be if I believe that you may be a risk either to yourself or another
person, where, as a psychologist, I would have the duty of care to make the necessary disclosures. You
would however where possible be informed of this.
I keep any records of your treatments secure in a handwritten note format. Any requests, usually by
yourself, for sharing of information electronically, if indicated, are encrypted, so that you cannot be identified.
For anyone under consent age, this is made clear to parents/caregivers. I, as a practise, do not use
electronic means of communication, except from arranging appointments (emails, SMS) - and if that is the
case, these are immediately deleted once appointments have been agreed. To reiterate, you have the right
to withdraw your consent to the information in this document at any time.
PROFESSIONAL SERVICE
The number of sessions required are highly individual and can range from anything between 6 to 12
sessions or even longer depending on individual circumstances. The sessions will normally be either once a
week or once every two weeks - again dependent on individual needs, with a possible one or two follow-up
sessions. I use a number of always up to date scientific psychological approaches in order to provide a
highly professional service with high regard to each individual receiving my service and is monitored from
accredited professional bodies in terms of continued professional development. As part of your treatment I
will ask you to fill in a few questionnaires regarding your mental and physical health. I may also ask you to
keep a personal ‘lifestyle book’ - which is a record of your sensations, feelings, thoughts & behaviours and
individual goals - this is entirely personal to you. This is a measure so that you do not find yourself in a
passive listening position when you are in therapy and also serves to jog your and my memories between
sessions. Everything is kept highly confidential. The only situations, which is rare, where I would have to
seek others’ involvement (e.g. GP, close family members/parents) are in situations where yours or others’s
wellbeing would be at risk.
BUSINESS POLICY
I am required to keep appropriate treatment records of my services. These will be brief and kept secure and
confidential. The records will mainly consist of information regarding your reasons for seeking treatment,
treatment goals and progress and invoicing details. You have the right to a copy of your details, except in
the unusual circumstances that involve danger to yourself. Because these are professional records, they
may be misinterpreted and/or be upsetting to untrained readers. For this reason, I recommend that you
initially review them with me and/or other mental health professionals before sharing them with other people.
Also by signing this agreement you allow me to contact your GP should I have any concerns about your and/
or others safety in accordance with the Privacy Details policy above.
SESSIONS
I will ask you to agree to give at least 24 hours notice if you are unable to attend a session. A small fee is
payable for nonattendance to cover clinic space hire fee, administration and transport. Each session lasts approximately 50-55 minutes.
HOW TO GET IN CONTACT WITH ME:
You can find me at: Holt Treatment Rooms; Holt, Norfolk, England, United Kingdom - Tel: 01263 711712
Phone me on: 07552 184 289. Or email me via the form above.