Please note this form is for Adults over the age of 18 years.
The information you provide in this form is very useful to use in terms of demonstrating who is using the service and monitoring its effectiveness. The information is kept completely confidential and will never be shared with anyone outside of the service.
If you would prefer not to share any information with Rotherham and Barnsley Mind please select the 'prefer not to say' option as appropriate.
Terms and conditions
Counselling is a deliberately undertaken activity and relationship requiring your commitment as well as that of your counsellor. As such, please read carefully the following terms and conditions which lay out what we expect from you and what you can expect from us in relation to your time in the service. By ticking the box below you agree to these terms and conditions.
All counsellors at the Rotherham and Barnsley 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 BACP. Counsellors receive regular clinical supervision of their work.
Copies of Rotherham and Barnsley Mind's policies on confidentiality, safeguarding children and safeguarding adults are available on request.
Rotherham and Barnsley Mind will not tolerate any form of abuse, disrespect or aggravations towards our counsellors, and we reserve the right to discontinue your appointments with immediate effect if this is not respected.
If we suspect you to be under the influence of alcohol or drugs when presenting for an appointment then the appointment will not go ahead.
The service reserves the right to decline a referral or to terminate therapy if we feel it is likely to impact negatively on the wellbeing of either the client or therapist. We will always seek to discuss this with clients with the aim of identifying appropriate alternative support in these instances, on a case by case basis.
Counselling sessions usually take place weekly and last for 50 minutes. If you arrive late to a session, the session will still finish at the normal time or the counsellor can decide not to go ahead with it at all.
For counselling to be effective you need to make a serious commitment to attending sessions. As such, we operate the following policy with regard to missed sessions:
If you anticipate having trouble attending your appointments, or if your regular appointment time becomes inconvenient (due to work or childcare commitments, for example) please discuss this with us as soon as possible and we may be able to work around it or make alternative arrangements.
You will have an assessment prior to your counselling appointments, which are charged at a fixed fee of £25. This will give you an opportunity to:
Please note that we can only run assessments at certain times. You will be expected to attend within working hours (09.00-17.00) and should be prepared to take time off work (as a one-off) to attend if necessary.
The counselling process is bound by rules of confidentiality. This means that what you say in therapy is treated as confidential to your therapist within the counselling practice. Counselling practice includes discussing clinical aspects of your work together within clinical supervision sessions and liaising with the counselling service Team Lead. All information held by the service is in accordance with the Data Protection Act 2018.
Rotherham and Barnsley Mind client privacy statement
Rotherham and Barnsley Mind is committed to protecting and respecting your privacy and keeping your data secure. By providing us with your data you are giving us consent to process your data. We will only process your personal data to provide you with the service that you have requested from us and provide anonymous feedback to our commissioners and funders.
To read our full client privacy notice please visit: https://www.rbmind.co.uk/about-us/privacy-policy/
or contact us at: 1 – 2 Highfield,
S65 1DZ. 01709 919929
Please indicate that you accept the terms and conditions of the counselling service by clicking below.
If you do not agree then unfortunately we will not be able to accept your referral.
Please note this form is for Young People under the age of 18 years.
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