1. Purpose of Therapy By signing this form, I give consent for my child to engage in psychological therapy with Dr. Michelle Clark. The therapy aims to support their emotional and psychological well-being. 2. Confidentiality Information shared in therapy sessions will remain confidential unless: There is a risk of harm to the child or others. Disclosure is required by law (e.g., concerns about abuse or neglect). In such cases, I understand the psychologist may need to contact appropriate authorities, such as social services, while prioritising the child’s safety and well-being. 3. Parental Involvement I understand that the psychologist is not obligated to share detailed session content with me, except when it is in my child’s best interest or in cases of risk. 4. Payment Terms Fees for each session are £130, payable at least 48 hours before the first session and within 24 hours of all subsequent sessions. Cancellations require at least 48 hours' notice. Missed sessions or late cancellations will be charged at the full session rate. 5. Other Services I understand I would be charged the hourly rate on a prorated basis for other professional services required. Other services may include reading or writing reports, telephone conversations exceeding 15 minutes, attendance at meetings, consultations with other professionals upon your request, and preparation of reports and letters to other health professionals, including GPs and psychiatrists. 6. Communication I agree to provide accurate contact details and understand that email and phone communication will be used only for administrative purposes or urgent matters unless falling in to the category of 'other services' above. 7. Data Protection I have read and understood the privacy policy, and I will process any shared data in line with the General Data Protection Regulations (GDPR). 8. Therapy Outcomes I understand that the therapist can give no guarantee that the therapy and provision of services will result in an improvement to the client’s mental or physical condition or general well-being. 9. Termination of Therapy I understand I can withdraw my consent for therapy at any time by providing written notice, though fees for completed sessions remain payable. Acknowledgment and Agreement By signing below, I confirm that I have read and understood this form and agree to the terms outlined above.