Registration
Offload online counselling - Registration Form
Completing this form confirms that you have familiarised yourself with the information provided,
including the cost of my encrypted online counselling email responses.
This is sample only. Please do not complete this form until requested to do so.
You agree to the following:
You are a UK resident aged 21 or over and have read the information on this website, including Safeguards and Terms of Service.
You are not suffering from severe mental illness such as schizophrenia or manic depression (bipolar disorder).
You agree to find appropriate services should you require emergency assistance.
This service does not in any way provide emergency assistance of any kind and that any help or advice offered is of a therapeutic not medical nature.
No warranty or guarantee can be offered through these services as to the effectiveness of counselling in all cases.
I hold no responsibility for direct or consequential loss due to internet service failure or computer malfunction.
No information disclosed to me during email counselling will be disclosed to any other person, apart from during supervision sessions where I discuss my casework without identifying individuals by name or personal details. The only other time information would be disclosed to an outside professional would be if at any time I believed a client to be a threat to themselves or to others and I would aim to seek prior consent.
At any point either of us may decide to discontinue our counselling relationship but we will aim to discuss this first if possible.
You will please avoid engaging in counselling whilst under the influence of alcohol or drugs.
You accept the boundaries of our counselling relationship.
You will not share any of my personal details with anyone without my prior consent.
Name
Date
Email address
Country of residence
Contact email/number of GP or close friend/family member (for emergencies only)