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Dr Alesia Moulton-Perkins
Psychological therapy and counselling via ‘Skype’

supervision-online-cbt.jpg

Dr Alesia Moulton-Perkins
Psychological therapy and counselling online.

supervision-online-cbt.jpg

Dr Alesia Moulton-Perkins
Psychological therapy and counselling via ‘Skype’

supervision-online-cbt.jpg

Dr Alesia Moulton-Perkins
Psychological therapy and counselling via ‘Skype’

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Client Details Form

form-3723115_640
Client Details Form It collects personal details, consent for electronic communications, explains the limits of confidentiality and special arrangements for clients outside the UK. Who is it for? For face to face therapists For online therapists When is it completed? This is completed by ...Read more
£ 33.00 each


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  • Description

Client Details Form

It collects personal details, consent for electronic communications, explains the limits of confidentiality and special arrangements for clients outside the UK.

Who is it for?

  • For face to face therapists
  • For online therapists

When is it completed?

This is completed by the client when they first book a session with you.

What does it contain?

  • Personal details
  • GP details and consent to contact them
  • Consent to communications e.g. appointment reminders, answer phone messages etc
  • Next of kin/emergency contact details, a short explanation why I collect that info including limits of confidentiality and special arrangements for clients outside the UK
  • How did you find me? Tracking referral sources
  • Health insurance details
  • Service evaluation: consent for collecting anonymised data for service evaluation and audit purposes

What format does the document come in?

  • Microsoft Word Template: Editable and unbranded so you can add your own branding
  • PDF Template* in Five Colourways (Teal, Orange, Charcoal, Lime, Navy): Editable and unbranded so you can add your own branding
  • Online Psychology and Counselling PDF: Non-editable fully branded example

Add to cart

 * Please note the PDF templates are partially editable. You can insert your logo and company name and fields are available for clients to insert their information. However, as they are PDFs certain formatting features are fixed. You can however fully edit the Word documents which contain identical content.

 

Dr Alesia Moulton-Perkins

Online Psychology and Counselling Limited.

Registered company in England and Wales (Companies House 10940785)

Registered office address: Online Psychology and Counselling Ltd, Philips House, Drury Lane, St. Leonards-On-Sea, East Sussex, England, TN38 9BA

Legal disclaimer and privacy policy

ACTO 2020 Level 2 Professional Member