Client Intake Information

Personal Details

Information about you, including professional records that are required by the laws and the standards of my profession, will be kept strictly confidential. Please be aware of the following exceptions to the law:

  • If you present a danger to yourself or others, have a legal requirement to help keep you safe and a duty to warn potential victims
  • If ordered by a judge in a court of law, I am required to provide access to your records; however, I would first assert legal privilege in an effort to protect your confidentiality
  • I will discuss your case with my supervisor, Dr. Jonathan Katz to seek further guidance, if necessary, to support you in the most optimal way, whilst keeping your identity confidential.
  • Further information regarding the protection of tour confidentiality can be found in the British Psychological Society Code of Ethics and Conduct

Payment Agreement

Consent to Consultation

I have read and discussed both the confidentiality statement and BPS code of ethics and conduct. I have been given a copy of the code of Ethics. I am willingly consenting to working with Natasha Bains under the parameters stated in those documents.