I, ________________________ have been advised of the scope of the services provided by Clare Downham of Unique Journey (“Practitioner”) and I give my full consent to receiving sessions by my Practitioner. I understand that results vary, and that no particular outcome is guaranteed.
I understand that these services are not a replacement for medical treatment, psychological or psychiatric services or counselling. I also understand that I will not be treated, prescribed for or diagnosed of any condition.
I am aware and understand that in some cases it may be necessary for the Practitioner to respectfully touch my shoulder(s), hand, knee or wrist in order to assist me during the session . By signing below, I give the Practitioner permission and consent to do so.
I have been advised that I am free to terminate any or all sessions at any time. I have agreed to
participate in each session to the best of my ability. I have accurately provided background information as requested by my Practitioner.
Absolute confidentiality will be maintained, unless the Practitioner reasonably considers that disclosure to a third party is necessary to prevent harm to yourself or to others or if such disclosure is required by law.
I am aware and understand that my relationship with the Practitioner will be a professional therapeutic one. I understand that in public my Practitioner will follow my lead in relation to any acknowledgement/conversation regarding our relationship.
I understand and agree that my Practitioner may make notes which together with any information that I provide or may be received concerning me will be processed in accordance with the GDPR or other relevant legislation.
Payment and cancellation
I understand the following:
- That both block booking and individual sessions are to be paid for at least 48 hours before the session time or the session may be reallocated.
- Payment is non-returnable if the I cancel the session with less than 24 hours’ notice.
- If payment is made for a block of sessions these must take place within 4 months of the date of the first session. No refund will be given in respect of any untaken sessions.
- All cancellations must be made by telephone to the Practitioner. Leaving a voicemail is acceptable but a text message or email is not.
I understand that this agreement is legally binding both upon the Practitioner and me.
Signature of Client and date: _______________________________________________
Parent or Guardian signature if required: _____________________________________
In order to support you in deriving maximum benefits from our scheduled time together, I agree to:
- Use my abilities and expertise to facilitate such changes as we agree to be in your best interest and in no way harmful to you.
- Treat you with respect and honour your trust (including complying with your wishes concerning confidentiality) and not misuse your trust for personal needs in any way. Endeavour to ensure that all suggestions given are positive in direction, beneficial in nature, and present within a context of health and well-being.
- Offer you my undivided attention and professional assistance during our scheduled consultations.
- Inform you if, in my judgment, you would be better served by another professional or an alternative/complimentary means of reaching your goals.
- Avoid postponing or seeking to rearrange appointments with less 48 hours’ notice unless there are extenuating circumstances.
Whilst I cannot guarantee any outcome, I am professionally committed to assisting you, in the shortest possible time and at the lowest possible cost in mobilising your resources to achieve maximum results.
Practitioner Signature: ___________________________________________________