Under the General Data Protection Regulation 2018 I am required to give you information about the type of personal information I collect from you and how I intend to use this information. By signing this form you agree to the terms and conditions set out below.
Collection of Personal Information
I may collect:
- basic information such as your name, gender and date of birth, in order to get to know a bit about you;
- contact details such as email, address and mobile phone number, so I can contact you in order to arrange appointments or communicate regarding our work together;
- emergency contact details in case of a medical emergency;
- your GP’s contact details, which I may use with your consent or if I feel there is a risk of serious harm to yourself or someone else, in which case I may need to contact them as part of my duty of care;
- assessment notes (sensitive personal information such as medical conditions, prescribed medication, mental health diagnoses and counselling history) in order to gain a clearer picture of your mental health and personal history; and
- payment details (if you pay by BACS), which will be held in my business bank account.
Storage of Personal Information
I will store:
- paper records such as contact details, Initial Assessment Form and a signed copy of this Privacy Policy, in a locked file for 5 years after our last session together; and
- electronic data such as Session Notes, email and SMS correspondence, on devices that are password protected and accessed only by myself; I will retain Session Notes for 5 years, and any emails and SMS correspondence for 2 weeks, following our last session together.
Please note that all Session Notes and Initial Assessment Forms will be anonymised and kept separately from any contact information that might identify you.
Processing / Sharing of Personal Information
It is very unlikely that I will share your personal information. I will not sell it or use it for unethical reasons. Examples of instances in which I might need to share your personal information without your explicit consent include:
- if I believe that you or another person (or persons) may be at risk of serious harm, in which case I may have to break confidentiality and contact a suitable authority (e.g. your GP or the emergency services); although I will usually attempt to gain your permission before breaking confidentiality in these instances, I retain the right to do so without your consent;
- if I become seriously ill, hospitalised or pass away my Therapeutic Executor (another counsellor I have chosen to cover such situations) may need to contact you to inform you of the situation and to advise you of your options; and
- if I am required to do so by law (e.g. to pass on information relating to acts of terrorism or on-going abuse of a minor or vulnerable adult).
Your Rights
You have the following rights with respect to your personal information:
- to request a copy of the personal information I hold on you (free of charge and within one calendar month);
- to request that I rectify any inaccurate or incomplete personal information;
- to withdraw your consent for me to use/process your personal information
- to request that some or all of your personal information be deleted; I can, however, decline this request whilst the information is needed for me to practise lawfully and competently; and
- to complain to the Information Commissioner’s Office (www. ico.org.uk) if you are unhappy with any aspect of the way I have handled your personal information.
Signed ……………………………………………………………
Name ……………………………………………………………
Date ……………………………………………………………
Copyright © 2019 Alexandra Park Counselling - All Rights Reserved. All images copyright © Edith Dorsey Raff.
Kim Davies
kdavies@alexandraparkcounselling.com
07799 476 210