1. Purpose of Therapy By signing this form, you give consent for your 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, you 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 It is good practice to involve parents and carers in psychological therapy. However, this will be subject to the consent of the primary client/young person. Agreeing to pay for sessions does not entitle parents and carers to knowledge of session content. 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. Unfortunately no exceptions can be made in cases of illness. 5. Other Services You understand you 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 You 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. TWP is not a crisis service and cannot be relied upon to respond to communications outside of the agreed session time. You agree to keep the clinician updated on any events relating to risk and safeguarding concerns, including self-harm and suicidal ideation. 7. Data Protection You have read and understood the privacy policy (published on our website) 8. Therapy Outcomes You 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 You understand you can withdraw your consent for therapy at any time by providing written notice, though fees for completed sessions remain payable. Acknowledgment and Agreement By adding your name below, you confirm that you have read and understood this form and agree to the terms outlined above.