Input your data

Please use this form to apply to New Day Counselling yourself or to refer someone else. If you are referring someone else, give the potential client's details as appropriate.

* denotes a required field

First name *

Last name *

Date of birth *

Address *

Phone Number *

Please give details of days and times

(eg mornings, evenings) when you are available

(or unavailable)

If you are referring someone else, please fill in

your name and contact details here

Please tell us your main issues and current

symptoms that require counseling or therapy *

Submit

Please read and agree to our terms and conditions

Our guarantee to you

• We will provide a counselor or therapist who is suitably trained to help you.
• We will treat you in a professional manner with empathy and consideration.
• We will respect your identity, beliefs and lifestyle choices.
• We will give you advanced notice if we have to change one of your seesions for any reason.

Your undertaking to us

• I will keep appointments or let my counsellor or therapist know as soon as possible if I need to cancel.
• I will not come to appointments under the influence of alcohol or non-prescription drugs.
• My mobile phone will be switched off or silent during sessions (unless agreed otherwise with your counsellor for a specific reason).

Payment

• The fee per 50 minute session is £40. Payment for counselling sessions is required via bank transfer and must be received at least 24 hours prior to your scheduled session to confirm your appointment.
• Payment should be made by bank transfer to our accout "New Day Counselling LLP" Account number: 63371161-00 Sort code:08-92-50.
• o If you need to cancel or reschedule your appointment, you must notify your counsellor at least 24 hours in advance. Cancellations made less than 24 hours in advance will require payment in full, as the time has been reserved exclusively for you and room fee paid. If the session is rescheduled with adequate notice, any payments made will be applied to the new appointment.

.. I understand and agree to this undertaking.

Data protection and Confidentiality

• All personal data is kept securely and only used to facilitate my use of New Day Counselling services.
• My name, phone number and e-mail address will only be stored on my counsellor's phone with my permission and in order to facilitate change of appointments, etc.
• My data may be used in written work as part of counsellor ongoing training, in counsellor supervision or for research. However, I understand that no data that enables me to be identified will be disclosed in this way.
• New Day Counselling keeps personal data and session notes for 3 years after which they are deleted. Texts and e-mails will be deleted as soon as no longer needed administratively.
• My information will not be shared with any third party without my permission unless:
  a. There appears to be high and imminent risk to my own or another's safety,
  b. Disclosure has a high likelihood of being effective in preventing serious harm,
  c. Rare legal obligations require disclosure.

.. I understand and agree to this policy.

Grievances

• If you have a grievance about any aspect of New Day Counselling's service, please first speak to your counsellor or therapist. However, if you still feel dissatisfied then contact the directors by letter addressed to: New Day Counselling Directors, 85 Church Street Leigh WN7 1AZ)

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