Counselling Contract

Please read and fill in the form below.

Sessions

Each counselling session lasts for 50 minutes. We will agree on a regular, weekly time and day on which to meet. I will set this time aside for you, and I will not use it for any other purpose. Sessions that you miss or cancel without 12 hours’ notice will be chargeable at the full fee. I will not cancel appointments at all unless it is unavoidable. Should I need to cancel, you will not be charged, and I will endeavour to reschedule it for you. I will give you advance notice of breaks and holidays.

Payment

Payment should be made via bank transfer before each session.

Online

Please ensure you are logging in from a quiet and private environment where you have a good internet
connection. Please dress appropriately and refrain from eating (beverages will be permitted, provided they are prepared beforehand).

Duration

Counselling may last for a few weeks to a year or more, the duration of which will always be open to review. You may decide to make a contract for a specified number of sessions or continue on an open-ended basis. When the time comes, I will plan the ending with you so that you work towards finishing counselling. You can stop counselling any time but if you wish to stop before a planned ending, I hope you will discuss this with me.

Professional Responsibility

I am licensed by the Israeli Board of Social Work and work within an ethical framework. I receive professional supervision of my work. Protection of your interests, especially confidentiality, is of the highest priority and I provide the maximum confidentiality that current law allows. Nothing you tell me will go outside the appropriate boundaries of professional confidentiality without discussing this with you first. I will not disclose any information unless I am required to do by law. I work in accordance with the International Social Work Code of Ethics (6.1) which states: Social workers respect and work in accordance with people’s rights to confidentiality and privacy unless there is risk of harm to the self or to others or other statutory restrictions. I will need to have your GP contact details, however any contact will only be after discussion with you.

If anything in this agreement is not clear to you, please ask and I will explain in more detail. Please sign below to indicate that you have read and understood this agreement.
Indemnity Agreement

I understand that all clinical information will remain strictly confidential. I further agree to indemnify and hold harmless Maria Beider from any claims for damages of any nature arising out of, or allegedly due to, any counselling, instruction or advice rendered by her or out of any activity related thereto.

I understand that Maria Beider is an independent counsellor and that no claims may be made against her by myself and/or any other person as a consequence of the therapeutic process, as well as any claims relating to matters either prior to or after the therapeutic process.

Maria will not engage in any psycholegal matters. Her services are purely for therapeutic purposes only.

Personal Details

Your Gp’s Details
Powered by NEX-Forms