Pre-Counselling Form and Information

If you have booked a counselling appointment with me please complete this form before our first session together. (If you are completing this on a mobile device, you press send,

and your entries disappear, the form has sent). I will email you to confirm I have received it. Thank you.

Counselling Information

Dovetail Counselling Service is at 6 Stafford Road, NP26 5DE. There is street parking. Entry is via the door on the garage (there is a sign saying 'Dovetail Counselling Service', and a bell for you to ring).

 

There is no waiting area so please arrive at your appointment time.

At our first session I will ask you to sign the following counselling contract -

 

Counselling Contract

 

I aim to give the best possible service to my clients.  The contract below sets out my commitment to you, and in return what I would consider to be your responsibility. 

I will:

  • Work to the BACP Ethical Framework for Counsellors. 

  • Be clinically supervised to ensure safe practice at all times.

  • Treat you with respect and without judgement.

  • Treat the work with confidentiality. Confidentiality will only be broken, with or without your permission, in the event of disclosure of abuse of children, other vulnerable people, serious criminal offences, or harm to self or others. There is also a duty to disclose acts of terrorism, under the terrorism act.

  • Make a commitment to you to attend every session, and to advise you in good time if this is not possible, for unforeseen reasons.

  • Meet with you at a time, day and venue agreed. 

  • Ensure the venue will be a safe place for us to discuss your issues

 

You will:

  • After the first session if you decide you would like to continue with counselling then I ask you make a commitment to attend regularly, in order for you to get the most from your therapy. This might be weekly, or fortnightly.

  • Inform me if you are unable to attend (less than 48 hours’ notice full fees apply).

  • Agree to engage in the process, being open and honest.

  • Agree a planned ending to the work with myself.  If you take the decision to end counselling prematurely I will respect your wishes, but would appreciate the opportunity to discuss this with you.

  • Agree not to be under the influence of substances.

 

Fee

Each session is booked for 50 minutes and at present costs £45. Once you have booked an appointment with me I ask that payment is made within 24 hours to secure that booking for you. Payment can be made by direct bank transfer or card on the fees page on my website.

​If you cancel or rearrange with more than 48 hours’ notice of the appointment time I will refund your money for a cancelled appointment or transfer the payment to the rearranged appointment. 

My fees are reviewed annually and I will give you four weeks’ notice in advance if I am increasing them. 

WhatsApp/Zoom Video or Telephone Counselling

 

If you are unable to attend my premises due to severe weather conditions, ie snow or flooding, travel difficulties, contagious illness or coronavirus (covid-19) restrictions I am able to offer the alternative of counselling via WhatsApp or Zoom video or telephone call. All video sessions are fully encrypted and GDPR compliant, meaning anything we discuss remains entirely safe and confidential.

 

Privacy Notice

You will have been given a privacy notice with this contract at our first session. This sets out how I manage and safeguard your data and the notes I take.

Coronavirus Agreement

 

As long as Covid-19 remains an active public health threat I will be taking all reasonable measures to comply with government regulations to maintain 2 metre social distancing, and extra cleaning and procedures to prevent possible transmission from objects or surfaces.

 

If you feel that counselling via WhatsApp or Zoom virtual or telephone call isn’t appropriate for you I will undertake face to face sessions if you meet the following requirements - 

  • If you, or someone else in your household, have not had symptoms of a fever, persistent cough and/or loss of taste or smell in last 14 days.

  • If you have not had any contact with someone who has been diagnosed with the coronavirus or had symptoms of a fever, persistent cough and/or loss of taste or smell in the last 14 days.

  • If you have been diagnosed with coronavirus but it is 14 days since your last symptoms. 

  • If you, or anyone else in your household, are not shielding. 

Preparation

Before each session contact surfaces will be sanitised and I will wash my hands. The counselling room furniture has been rearranged to ensure the chairs are 2 metres apart.

 

Arrival

  • After ringing the doorbell please stand back level with the number six door sign to enable me to open the door outwards and hold it open for you to enter, and maintain 2m social distancing.

  • Please go on into the counselling room and use the hand sanitiser provided on the table next to the chair farthest away.

  • I will follow, closing all doors.

During

  • With the government guidelines not to touch your eyes, nose or mouth if you do cry please do take some tissues to wipe your eyes, dispose of the tissues in the bin provided and then use some hand sanitiser. I will ensure the bin is emptied safely during sessions.

  • If you need to cough or sneeze please remember to follow the government guidance of doing it into your elbow.

  • A bottle of water will be provided. If you make use of this and there is any water left at the end of the session please feel free to take it with you.

  • Where possible I will keep a window open during the session. I will also ‘air out’ the counselling room during sessions.

  • If possible if you could use a toilet before you arrive. If not then please do use the paper towel provided to dry your hands.

Leaving

  • On leaving to maintain the 2m social distancing please allow me to open the door and leave the counselling room before following me.

After

  • During our time working together, or up to 2 weeks after our last appointment, if I develop any symptoms, I come into contact with someone who tests positive or I am contacted by the Government’s test and trace system I will notify you myself asap, and I will not give your details as a contact.

  • I ask that you also please keep me informed if you develop any symptoms, you come into contact with someone who tests positive or you are contacted by the Government’s test and trace system that you need to self-isolate.

  • If either of us needs to self-isolate then we would have the option to return to online counselling, or temporarily pause the counselling.

If you have any questions please do contact me before our session, otherwise I look forward to working with you in these challenging times.

Following Welsh Government Coronavirus Regulations. For more information see - https://gov.wales/taking-all-reasonable-measures-maintain-physical-distancing-workplace

Dovetail Counselling Service

07401 331521

6 Stafford Road, Caldicot, Monmouthshire, NP26 5DE,

©2018 BY DOVETAIL COUNSELLING SERVICE.