Sumie Macalpine-Downie 

COSRT accredited therapist offering Single Session, Brief and Open-Ended Therapy to individuals and couples



Please read and check through this agreement before making a booking.

You will be required to complete and return this agreement to before your session.

Making and paying for an appointment for a Single Session Therapy or for Ongoing Therapy creates a legally binding contract between you (the ‘Client’) and me (the ‘Therapist’).



Single Session Therapy: each single-session lasts for up to 60 minutes together with a short follow-up phone call or email approximately 6 weeks after the session.

Ongoing Therapy: this refers to both brief, time-limited and open-ended work. Each session lasts for 60 minutes. We will review how the work is progressing from time to time. 

Late arrival to the session, for any reason, will not extend the session time.



Single Session Therapy: £80 per session, payable in advance. This includes the follow-up phone call or email and pre-session preparation. 

Ongoing Therapy: £80 per session, payable on the day of the session.



All sessions will be conducted online via an encrypted service (Zoom or Microsoft Teams).



In the event that you need to rearrange your session, or if I have to cancel the session for any reason (for example, illness), I will discuss rearrangement with you as soon as possible.



Everything that happens in the session (including any records that I make) is confidential, with the following exceptions:

  1. where you consent for confidence to be broken.
  2. where I am required to break confidentiality by a court of law.
  3. where material from our work together is brought by me in my supervision. I will take reasonable steps to keep your identity protected.
  4. where the information disclosed is so serious that the law says that it would be unreasonable NOT to disclose it. For example, if you discussed acts of terrorism, fraud, money laundering, other serious crime or risk of serious harm to others, I would be required to report this to the police.
  5. where the information disclosed concerned children or vulnerable adults being at risk of harm, I would be required to report this to the relevant authorities.
  6. where I believed you were at serious risk of harm to yourself, I may contact your GO or other medical professionals for your safety.



GP Name:

GP Address:



Please do not take any mood-altering drugs (except as prescribed by your GP) or consume any alcohol before a session.


Notes and Record-keeping

I will make brief notes during and/or after the session which will be stored securely for a period of 7 years and then destroyed.

You have the right to view this information if you make a request in writing.

You have the right to ask for your personal information be shredded, deleted or erased. I have the right to refuse this request where I need that information to practice lawfully and ethically or if there is a complaint or legal request pending.

You also have the right to withdraw your consent for me to hold your personal information., in which case I would be unable to continue working with you.



You and I will always speak to each other with respect. We will not raise our voices, threaten violence or try to intimidate in any way. 


I am registered with the Information Commissioner’s Office (ICO) as Registration Number: ZA113801.

I am an accredited member of the College of Sexual and Relationship Therapists (COSRT).


This agreement is governed by the laws of England and Wales.


Client signature:


Print name:


Therapist signature:


Therapist Name: Sumie Macalpine-Downie




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