Terms and Conditions

1. CONSENT

During the course of your sessions we want to make sure that we fulfil all your expectations for confidentiality. We take confidentiality and data protection extremely seriously and we will always keep your information securely and only use it for the purposes of your treatment. During your treatment, we may need to share information about you with other people and we may need to ask others to share information about you with us. We would therefore like to know who we are able to contact with information about you and who we can ask to share information about you. For young people under 18 years of age, it is standard practice to always share information with the clients GP.

I understand that, as a client of DCC, my personal details (name, age, address, and date of birth), clinical details and medical records will be recorded on the DCC database for administrative, accounting and treatment purposes.

I also understand that therapy details and treatment progress reports may be shared with my Private Medical Insurer or third party.

2. PAYMENT

I understand that I am responsible for the payment of my care and that I will be invoiced by DCC on behalf of my individual therapist. Where Private Medical Insurance or guarantor details are provided below, invoices will be submitted electronically to the PMI or guarantor in the first instance.

Private Medical Insurance – If your treatment is funded by private medical insurance (PMI) please complete the following details You are responsible for ensuring your treatment is pre-authorised by your Private Medical Insurer and that your Insurer will cover the agreed type and number of treatment sessions. You shall be liable for all costs associated with treatment that have not been authorised by your Insurer (or which fall outside of the scope of your policy), including taking more than the authorised number of sessions.

3. DECLARATION:

I hereby consent to private treatment and understand that by signing this registration form, I am entering into a contract with DCC for the provision of psychotherapy/psychological counselling treatment.

I confirm that I understand and agree to the following:

• I agree to pay the professional fees for this treatment if not covered by Private Medical Insurance or other third party as agreed.
• To the best of my knowledge, the information I have provided on this Registration Form is accurate and complete.
• If any of the information provided on this form changes, I will update DCC accordingly.