The London Association for Counselling & Psychotherapy

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Patient Form		 
 
Form to publish your cancellation policy and your entry on the therapists list
 
Do you agree to work using the group practice cancellation policy? Yes, I can agree to that

No, please publish my own policy for all patients. I have completed the relevant entries below.

If you have agreed - can you just sign off & submit the form at the bottom and that's that! (ie all the buttons are preset to the group's policy.  You must actively change fields below to establish your own policy.

This form will remain on your members logon page, and can be used at any time if you want to make a change to the policy that you publish.

If you need to let us have the variant details - please continue below........
 These are the details of my own cancellation policy:
 
1. Cancellation notice periods 
 
Patient Holidays: will you charge as usual? Yes    No
  
 
3. Your own holidays & breaks: will you charge as usual? Yes    No
 
 
4. Other interruptions: will you charge?Things like work trips, illnesses over a period, breaks for care of relatives etc.

Yes      No

 
Statutory Holidays: will you host?If the session falls on a statutory holiday will you be asking the patient to attend as usual?

Yes, for some or all of these    No   

 
Statutory (Bank) Holidays?If the session falls on a statutory holiday will you be asking the patient to pay as usual?

  Yes      No

Any other comments you want on your policy statement?

I want to change what you publish about me in the therapists list.

Please amend my entry to read as below.

Type your name