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		<title>Therapeutic Agreement: &#038; GDPR Compliance Data Protection</title>
		<link>https://jaynetherapy.com/therapeutic-agreement-gdpr-compliance-data-protection/</link>
					<comments>https://jaynetherapy.com/therapeutic-agreement-gdpr-compliance-data-protection/#respond</comments>
		
		<dc:creator><![CDATA[Jayne Hills]]></dc:creator>
		<pubDate>Sun, 25 Aug 2024 18:21:44 +0000</pubDate>
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					<description><![CDATA[<p>Therapeutic Agreement: &#038; GDPR Compliance Data Protection Please select the box and read, Then fill in name  Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Therapeutic Agreement: In-Person &#38; Online Counsellor: Jayne HillsTherapeutic Agreement: Jayne HillsTherapeutic Agreement: In-Person &#038; Online Counsellor: Jayne Hills Please read [&#8230;]</p>
<p>The post <a href="https://jaynetherapy.com/therapeutic-agreement-gdpr-compliance-data-protection/">Therapeutic Agreement: &amp; GDPR Compliance Data Protection</a> appeared first on <a href="https://jaynetherapy.com">Jayne.Therapy</a>.</p>
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					<h2 class="elementor-heading-title elementor-size-default">Therapeutic Agreement: &amp; GDPR Compliance Data Protection</h2>				</div>
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									<p>Please select the box and read, Then fill in name </p>								</div>
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		<p>The post <a href="https://jaynetherapy.com/therapeutic-agreement-gdpr-compliance-data-protection/">Therapeutic Agreement: &amp; GDPR Compliance Data Protection</a> appeared first on <a href="https://jaynetherapy.com">Jayne.Therapy</a>.</p>
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		<title>Client Contact Form</title>
		<link>https://jaynetherapy.com/client-contact-form/</link>
					<comments>https://jaynetherapy.com/client-contact-form/#respond</comments>
		
		<dc:creator><![CDATA[Jayne Hills]]></dc:creator>
		<pubDate>Mon, 12 Aug 2024 21:26:53 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<guid isPermaLink="false">https://jaynetherapy.com/?p=4681</guid>

					<description><![CDATA[<p>Please enable JavaScript in your browser to complete this form.Full Name *FirstLastPreferred Name (if different): FirstLastD.O.B. *Home Address:Contact Telephone numbers: *Email *GP DETAILS *Surgery Name *Address Line 1 *Address Line 2 Postcode *Telephone No. *Next of Kin / Emergency Contact Person I may contact your emergency contact, GP, or emergency services if you become unwell [&#8230;]</p>
<p>The post <a href="https://jaynetherapy.com/client-contact-form/">Client Contact Form</a> appeared first on <a href="https://jaynetherapy.com">Jayne.Therapy</a>.</p>
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- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  - - - - - - - - - - - </label><input type="text" id="wpforms-4522-field_43" class="wpforms-field-medium" name="wpforms[fields][43]" aria-errormessage="wpforms-4522-field_43-error" aria-describedby="wpforms-4522-field_43-description" ><div id="wpforms-4522-field_43-description" class="wpforms-field-description">I may need to reach out to your emergency contact, GP, or emergency services if you become unwell or express intentions to harm yourself. Where possible, I will endeavour to inform you first.  Complete your preferred emergency contact point below:</div></div><div id="wpforms-4522-field_44-container" class="wpforms-field wpforms-field-name" data-field-id="44"><label class="wpforms-field-label" for="wpforms-4522-field_44">Emergency Contact Name <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-4522-field_44" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][44]" aria-errormessage="wpforms-4522-field_44-error" required></div><div id="wpforms-4522-field_45-container" class="wpforms-field wpforms-field-name" data-field-id="45"><label class="wpforms-field-label" for="wpforms-4522-field_45">Relationship to you:  parent/partner/son/daughter/GP/friend <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-4522-field_45" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][45]" aria-errormessage="wpforms-4522-field_45-error" required></div><div id="wpforms-4522-field_46-container" class="wpforms-field wpforms-field-name" data-field-id="46"><label class="wpforms-field-label" for="wpforms-4522-field_46">Emergency Contact Number 1 <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-4522-field_46" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][46]" aria-errormessage="wpforms-4522-field_46-error" required></div><div id="wpforms-4522-field_69-container" class="wpforms-field wpforms-field-name" data-field-id="69"><label class="wpforms-field-label" for="wpforms-4522-field_69">Emergency Contact Number 2</label><input type="text" id="wpforms-4522-field_69" class="wpforms-field-medium" name="wpforms[fields][69]" aria-errormessage="wpforms-4522-field_69-error" ></div><div id="wpforms-4522-field_71-container" class="wpforms-field wpforms-field-name" data-field-id="71"><label class="wpforms-field-label" for="wpforms-4522-field_71">- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  - - - - - - - - - - - </label><input type="text" id="wpforms-4522-field_71" class="wpforms-field-medium" name="wpforms[fields][71]" aria-errormessage="wpforms-4522-field_71-error" aria-describedby="wpforms-4522-field_71-description" ><div id="wpforms-4522-field_71-description" class="wpforms-field-description">On occasion, I may need to contact you outside of our appointment, for instance to rearrange or schedule a forthcoming appointment. To protect your privacy or safety, choose your preferred communication methods by ticking the boxes you're comfortable with me contacting you on:</div></div><div id="wpforms-4522-field_48-container" class="wpforms-field wpforms-field-checkbox" data-field-id="48"><fieldset><legend class="wpforms-field-label">Tick all that apply</legend><ul id="wpforms-4522-field_48"><li class="choice-1 depth-1"><input type="checkbox" id="wpforms-4522-field_48_1" name="wpforms[fields][48][]" value="Mobile Phone - Voice Call" aria-errormessage="wpforms-4522-field_48_1-error"  ><label class="wpforms-field-label-inline" for="wpforms-4522-field_48_1">Mobile Phone - Voice Call</label></li><li class="choice-2 depth-1"><input type="checkbox" id="wpforms-4522-field_48_2" name="wpforms[fields][48][]" value="Mobile Phone - Text/WhatsApp" aria-errormessage="wpforms-4522-field_48_2-error"  ><label class="wpforms-field-label-inline" for="wpforms-4522-field_48_2">Mobile Phone - Text/WhatsApp</label></li><li class="choice-3 depth-1"><input type="checkbox" id="wpforms-4522-field_48_3" name="wpforms[fields][48][]" value="Mobile Phone - leave voice message" aria-errormessage="wpforms-4522-field_48_3-error"  ><label class="wpforms-field-label-inline" for="wpforms-4522-field_48_3">Mobile Phone - leave voice message</label></li><li class="choice-4 depth-1"><input type="checkbox" id="wpforms-4522-field_48_4" name="wpforms[fields][48][]" value="Home Phone (if supplied) - Voice Call" aria-errormessage="wpforms-4522-field_48_4-error"  ><label class="wpforms-field-label-inline" for="wpforms-4522-field_48_4">Home Phone (if supplied) - Voice Call</label></li><li class="choice-5 depth-1"><input type="checkbox" id="wpforms-4522-field_48_5" name="wpforms[fields][48][]" value="Home Phone (if supplied) - leave voice message" aria-errormessage="wpforms-4522-field_48_5-error"  ><label class="wpforms-field-label-inline" for="wpforms-4522-field_48_5">Home Phone (if supplied) - leave voice message</label></li><li class="choice-7 depth-1"><input type="checkbox" id="wpforms-4522-field_48_7" name="wpforms[fields][48][]" value="Email" aria-errormessage="wpforms-4522-field_48_7-error"  ><label class="wpforms-field-label-inline" for="wpforms-4522-field_48_7">Email</label></li><li class="choice-8 depth-1"><input type="checkbox" id="wpforms-4522-field_48_8" name="wpforms[fields][48][]" value="Other Options - please provide details below" aria-errormessage="wpforms-4522-field_48_8-error"  ><label class="wpforms-field-label-inline" for="wpforms-4522-field_48_8">Other Options - please provide details below</label></li></ul></fieldset></div><div id="wpforms-4522-field_80-container" class="wpforms-field wpforms-field-textarea" data-field-id="80"><label class="wpforms-field-label" for="wpforms-4522-field_80">My preferred contact</label><textarea id="wpforms-4522-field_80" class="wpforms-field-small" name="wpforms[fields][80]" aria-errormessage="wpforms-4522-field_80-error" ></textarea></div><div id="wpforms-4522-field_82-container" class="wpforms-field wpforms-field-gdpr-checkbox" data-field-id="82"><label class="wpforms-field-label">GDPR Agreement <span class="wpforms-required-label" aria-hidden="true">*</span></label><ul id="wpforms-4522-field_82" class="wpforms-field-required"><li class="choice-1"><input type="checkbox" id="wpforms-4522-field_82_1" name="wpforms[fields][82][]" value="I consent to having this website store my submitted information so they can respond to my inquiry." aria-errormessage="wpforms-4522-field_82_1-error" required ><label class="wpforms-field-label-inline" for="wpforms-4522-field_82_1">I consent to having this website store my submitted information so they can respond to my inquiry.</label></li></ul></div><script>
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		<p>The post <a href="https://jaynetherapy.com/client-contact-form/">Client Contact Form</a> appeared first on <a href="https://jaynetherapy.com">Jayne.Therapy</a>.</p>
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