Supervision Contract

Penny Annesley

Counsellor and supervisor (MSc BACP accred)

Supervision Contract

This agreement is to clarify how I practice and to set out the terms under which I work so that they are clear. If at any time you have any concern or query please let me know as soon as possible.

Me

My name is Penny Annesley. I’m a counsellor and these are my qualifications and experience: MSc in Counselling from University of Bristol. Diploma in Supervision.

I have been working in private practice since 2011 as a counsellor. I qualified as a supervisor in 2014 and since then have worked as an external supervisor for a range of organisations as well as for individuals in private practice.

Fees and times

Each supervision session costs £65 per 60 minute session. Times will be agreed between us. Fees are reviewed annually and I will give you four weeks’ notice in advance if there is a change.

Payment should be made on the day of the session prior to the start time to:

Penny Annesley

Account 85254415

Sort code 089300

(Co-operative bank)

Confidentiality

All our work together is confidential and I will not disclose any information about you to a third party without your consent, subject to the following exceptions:

• Discussing my work during my own supervision, which I have monthly in accordance with the BACP requirements. This is to support me in my work with you and ensure that I work to your best interests. All supervisors are also bound by confidentiality rules.
• Some laws in certain circumstances require me to break confidentiality such as the Terrorism Act and Drug Trafficking Act. In certain circumstances I am required to break confidentiality without informing you.
• In extreme circumstances, if I believe you or someone else is at risk. I would endeavour wherever possible to inform you in advance.

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Location

Sessions can be online or in-person. I am based in a garden cabin at 181, Bishop Road, BS7 8NA.

Records

I keep brief notes recording the themes of our supervision sessions. These are stored in a locked filing cabinet and I keep them for three years before destroying them, unless agreed otherwise. Your appointment details will be kept for seven years and then destroyed unless agreed otherwise. Any emails, texts, Whatsapp messages or other communications will be deleted within three months. Your telephone number will be stored on my mobile phone under your initials or first name only until your sessions end, at which point it will be deleted. Your contact details will be deleted as soon as we have ended supervision.

Privacy notice

There is a privacy notice on my website outlining data management procedures.

Cancellations

If you are unable to make your appointment please let me know as soon as possible, with preferably 48 hours’ notice. There is no charge to rearrange a session or cancel if more than 24 hours notice is given.

If less than 24 hours notice is given the session is charged at the regular rate. I will also give you as much notice as possible whenever I will not be available.

Your agreement

 Please sign below to indicate that you have read and accept the form above. Thank you.

Signed (You) ……………………………………….                              Dated……………………………………….

Signed (PA) ……………………………………….                              Dated……………………………………….

Your contact details

Full name :

Date of birth:

Telephone numbers:

Email:

Address:

Please confirm whether you have made arrangements for your clients in event of accidents or other difficulties

YES/NO

Please confirm if you have made a living will

YES/NO