- 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
* 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, 71-75 Shelton Street, London, WC2H 9JQ
