Terms and Conditions Agreement Form
Terns & Conditions Agreement Form for services provided by
My Counselling approach
I accept non christian clients and christian clients .
I believe that my clients have the desire and the capacity to experience emotional and spiritual growth and understanding through knowing ,or be open and willing to get to know christian values to help overcome personal issues, and the worlds troubles , learnt through informed dialogue,questions and answers .
Through the sessions the client can understand the spiritual side to being a human being and to being open to lead to spiritual growth and healing.
I will encourage through emotional healing and well being. I follow the model of christian standards ,Attitudes ,Values and beliefs and lifestyle and aim to encourage my client to this understanding but never through force or pressure to comply.
I present and teach understandings of the Gospel and how to use it in your life & encourage commitment to Jesus Christ of Nazareth .Development of Christian values & biblical living.
Terms and Conditions
All services on this site are provided by Qualified Counsellor and hold a Registered Licence and Insurance by a Legal & Ethical Registered Industry Association .
The Counsellor hold a National Criminal Check ,Working with Children ID check and have full clearance.
All payments made on this website are Legitimate and are protected for security .
A Confirmation Agreement and /or Counselling Terms and Conditions Agreement Policy must be in place before commencement of Scheduled appointment.This will be sent AFTER payment , and BEFORE your appointment. It is necessary for the client to acknowledge the Agreement and consent BEFORE commencement of the counselling session.
All persons engaging in the counselling process must act in a respectful and courteous way to the counsellor.
NO disrespect or abuse will be tolerated . Counselling Phone sessions are strictly NOT of a sexual nature and any sexually explicit conversation directed at the counsellor will immediately lead to termination of the call through breach of specified terms and conditions. If termination occurs the person shall forfeit the right to reschedule and any unused portion of time paid will not be refunded.
____Yes I understand
Clients with serious Mental Health issues and/or that are being treated under another Professional Health Care provider such as , Psychologist , Psychiatrist or Mental Healthcare professional are advised to remain with their own registered Health professional so not to confuse and interfere with other treatments.
Are you having services by any other Health Professional ?
____Yes -Please advise____________________________________________________________________________
All personal Contact to Counsellors must be limited to Appointment ONLY and of a Professional Manner only unless stated otherwise by Permissions .No other contact must will be pursued other than a professional manner.
Policies on Refunds before sessions have begun
Refunds shall only be permitted back to the client ( Allow 7 days ) when emailed with written reason within a 24 hour period from the TIME of the appointment. After the 24 hour period has elapsed , we have the right not to refund however we can happily accommodate and reschedule another appointment time to suit the client .
If the appointment has been re-scheduled more than 3 times and 3 times cancelled , then no futhur rescheduling shall occur and no refund shall be given.
____Yes I understand
Session times and Fees
The counselling sessions are in units of 3 x one hour sessions in a routine time frame Example - Same time every week.After the sessions are complete the client may extend for other required sessions if need be.
The fee is $93 per hour /$ 280 for three sessions and a 25% discount can apply for Social Security , Student or Pensioner .Please show your concession card for discount to apply.
Please Note Fees may increase or decrease without notice on this website.,Clients already under services will be notified.
Payments can be paid on PAYPAL .....paypal.me/leighkerr
Pay to- Leigh Kerr BSB NO - 733 0610 ACC NO- 637 597
My preferred method of payment is ___________________
Ending your session early once you have started..
Normally the end of the session would be by mutual prior arrangement. However you have the right to end your counselling at any time .I would appreciate you letting me know 24 hours prior to a session or longer if possible.
If you felt the sessions were not right for you, I can learn from your experience through a discussion or questionaire. If you require a referral I can happily provide this for you.
Our clients confidentiality is very important to us.
All sessions are private and confidential.
Video sessions are NOT recorded.
The Counsellor has the right to make documentation and notes of the sessions to keep up to date with all clients sessions and progress. All note taking procedures are kept for the use of client records. These records are kept in a safe locked file at all times with no outside access. Any computer files are kept with secret password.
Reasons for breach of Confidentiality can occur for these following reasons-
-If subpoenaed by a Court of Law to do so.
-If you are about to harm yourself or someone else.
-If you have confessed an act of harm to someone else . ( Child Abuse, Neglect, Murder, Serious harm or Injury)
The Counsellor is mandatory required by Law to divulge information to the required Authorities.
-If someone requests information about you and you given permission to disclose - Note: This will only be given with written permission form the client.
___YES I Understand
I Have read the Counselling contract and the Terms and Conditions
I understand all the information I have read and have I discussed anything of concern or anything I do not understand prior to signing. I understand this is a Routine procedure that Health Professionals adhere to before commencing with clients.
Please Sign and Date
This client questionnaire is designed to outline the reasons why you have come to Counselling and to ask a few questions to get to know you and your situation better.
Give a Brief outline of the reason you have sought Counselling .
Are you New to Christ ?
What would you like to achieve by seeing our Counselling Staff?
Do you have specific queries or questions you would like to ask -Please give examples.
Thank you . In providing this information as an outline of your session, we hope to get the best results and provide the right information to our clients. We appreciate your support.