Telephone/Video Call Counselling Agreement

Confidentiality - We will take all precautions to ensure our online communication, whatever medium, remains private and confidential. Likewise, if you prefer to keep our meetings private, please think about where you are able to engage in our sessions, somewhere you will not be disturbed by others.

Responsibility around confidential information - You are responsible for understanding the potential risks of confidentiality being breached. This will be for securing your own device hardware, your internet access points, chat software, email address and any passwords.

Legal exceptions - The information disclosed during counselling is confidential. However, there are legal exceptions including threats of harm to self or others, or if a court ordered.

Technical Failures - Transmission could possibly be disturbed or distorted by technical failures. If for any reasons we are unable to connect or we are disconnected during a video call meeting due to technological breakdown (crash or freeze etc.). We will try to reconnect within 10 minutes. If reconnection is not possible, we’ll email you or message you to schedule a new session time.

Lack of non-verbal cues - You should be aware that misunderstandings are possible in online counselling. Counsellors are observers of human behaviour and gather much information from body language, vocal reflection, eye contact and other non-verbal cues. If this is your first time in on-line counselling, have patience with the process and clarify information if you think we have not understood you well.

Sessions - We can offer you sessions according to your need. This will be discussed with our Clinical Lead prior to the start of your sessions. The number and frequency of sessions may be changed if required. Please have this conversation with your counsellor.

 

Cost – Sessions are free to all families who meet our criteria to access our service.

 

By signing this form, you agree to participate in online counselling with associated monitoring and evaluation via forms and video.

I have read, understood and comply with the agreed upon policies.

Name:

Signature:

Date:

 

Please, download and print this form, sign and then email a copy to [email protected] If you do not have access to a printer please do sign digitally and return.