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Following Intake Form and Confidentiality Agreement have to be submitted on the first individual session

Intake Form

Name and Signature of Client:___________________________________________________  

 

 

Date:________________________________

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Confidentiality Agreement
 

You, the Client, hereby agree to the following Terms and Conditions.

 

This agreement governs any counselling/art therapy services provided to you or other persons that you are nominating to interact with Woods Counselling and Art Therapy.

 

1. Woods Counselling and Art Therapy considers that the data we collect and record from you is true and accurate. You can request to update this data at any point in the future. In the event that you choose to conceal certain information, please be mindful that this may have adverse effects on your therapy progress.

 

2. Your personal information will be confidentially stored, and only disclosed to a third party with your permission, or if required by law or a court order. In addition, Woods Counselling and Art Therapy reserves the right to alert authorities if your safety or that of others is at risk. All materials remain the property of Woods Counselling and Art Therapy.

 

3. You agree that Woods Counselling and Art Therapy is not responsible for any loss you suffer, of any nature, from the use of Woods Counselling and Art Therapy’s website or our counselling/art therapy services. We exclude from any loss liability to the fullest extent permitted by law. We expressly disclaim any liability for any omission, inaccuracy, error, or misstatement in the content or materials that are provided to you or posted on our website www.woords-counselling-art-therapy.com

 

4. Extensions to your therapy sessions are calculated in blocks of 15 minutes, unless you have made a different agreement with your Counsellor.

 

5. Matters such as rescheduling therapy, checking homework, and discussing admin matters are considered as part of the therapy session. While sessions are typically scheduled for 60 or 90 minutes, please allocate 5-10 minutes of this time for wrapping up and making another appointment, if needed. Please bring up any important matters at the start of your therapy session, as your Counsellor is unlikely to have the necessary time to address any important matters brought up towards the end of your session.

 

6. Please consult with your Counsellor for the different rates that may apply for atypical services, such as outcalls and writing reports. Such fees are calculated as a function of time and day, venue (e.g. outcalls), and the nature of the services that are provided. New rates, if any, shall be applied to clients who have not had a session in 3 months or more.

 

7. Please be punctual for your appointments as your sessions continue to conclude at the scheduled time in the event that you arrive late.

 

8. For rescheduling or cancellations of appointments, please note that we require a minimum 48-hour notice* prior to the scheduled appointment time. Our policy is that cancellations made in less than our notice period incur 100% of the session fee (unless a special arrangement has been made with your Counsellor).

Name and Signature of Client

Date

Thanks for submitting!

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