Clarence House, 11 Clarence Road, Horsforth, Leeds LS18 4LB Tel: 0113 3055802
September 2012

Counselling is a deliberately undertaken activity requiring joint commitment from both counsellor and client. Leeds Mind Counselling Service believes clients have the right to dignity, respect, confidentiality and safety.

All counsellors at Leeds Mind Counselling Service work within the British Association for Counselling and Psychotherapy’s (BACP) Ethical Framework for Good Practice.
Copies are available on request or directly from the BACP.

Sessions are on a weekly basis, lasting 50 minutes. You are expected to attend each session and to pay the agreed fee for each session.

If you arrive late for a session it still will end at the original finishing time.

You can state your preference to be offered brief (3 sessions), short-term (12-20 sessions), or an open-ended contract (no specific end date except as negotiated between you and your counsellor). You are able to renegotiate after you have begun your counselling or at the end of your agreed contract, though it may result in you being put on a waiting list for another counsellor if your counsellor is not available.

A follow-up session can be offered, as negotiated between you and your counsellor.
Follow-up sessions will usually take place after a short break from the contracted work.

If, due to illness or other unforeseen circumstances, your counsellor needs to cancel the session, we will make every effort to contact you in good time.

If you need to cancel a session please give at least 24 hours notice and more would be helpful to us. If you do not attend a planned session or cancel at less than 24hours’ notice, you will be charged your usual fee for the missed session.

Completion of this form includes the chance for you to state which pay band (on the scale of fees) you fall into. We may ask you for further information on your income in order to accurately determine your fee amount before you begin seeing a counsellor.

For counselling to be of benefit it is important that you attend regularly. Frequent cancellation of sessions may result in the service being withdrawn, though your counsellor would usually discuss missed sessions with you and give you a chance to explore what is happening and understand why you are not able to attend regularly.

If you miss any sessions without informing us the service may be withdrawn, so it is important that you inform us as soon as you know you cannot attend an appointment.
 If you wish to end the counselling, please give at least one session’s notice.
1


At the end of counselling you will be given or sent an evaluation form to complete to provide Leeds Mind with feedback about our service.

If you have been referred by another professional, Leeds Mind Counselling Service will inform your referrer that you have been seen and, if counselling is agreed, that we are offering you appointments (unless you tell us that you do not want this).

The counsellor receives regular clinical supervision of all counselling work.

No violence or threatening behaviour will be accepted.

If it is suspected a client is under the influence of alcohol or drugs the counselling session will not go ahead.
Fee Band

Based on my total income, I believe I fall into band:………and will pay a per session fee of £…………………
I have read, understood and agree to the Terms for my counselling (to be completed and returned with your self referral forms).
Client Signature: …………………………………………………………… Date ……………..
Print Name: …………………….……………………………………………
Counsellor Signature: …………………………………………………….. Date ……………..
(On behalf of Leeds Mind)
Print Name: …………………………….……………………………………
If you have any problems with any aspect of our service please contact the Counselling
Coordinator who will try to resolve any issues or complaints to your satisfaction.
A ‘Feedback, Compliments, Complaints, Suggestions’ leaflet is available from reception
2