INFORMED CONSENT FOR PSYCHOLOGICAL SERVICES
private psychological practice
1. SPECIALIST INFORMATION
Full name: Yuliia Serhiivna Kotliarevska
Qualification: psychologist
Approach: integrative approach to psychological counselling
Contact details:
- Phone: +38 099 452 03 23
- Email: yopsihology@gmail.com
- Telegram: https://t.me/yuli_kotliarevska
2. FORMAT AND TERMS OF SERVICE
Session duration: 50 minutes.
Frequency: agreed individually.
Format: in-person or online session (by arrangement).
Fee: €30 per session.
Payment: full payment in advance before the consultation.
Cancellation / rescheduling: if an appointment is cancelled less than 24 hours before the consultation, the payment is non-refundable.
3. PURPOSE AND APPROACH
Psychological counselling using an integrative approach combines techniques from different schools of psychology (Cognitive Behavioural Therapy, humanistic psychology, body-oriented approaches, psychodynamic elements, etc.) according to the individual needs of the client.
The goals of the work are agreed together with the client and may include:
- working through emotional difficulties, anxiety and stress;
- improving relationships with yourself and others;
- developing self-regulation and decision-making skills;
- support during crises or periods of transition;
- personal growth and self-understanding.
4. VOLUNTARY PARTICIPATION
Participation in counselling is entirely voluntary. The client has the right to:
- stop counselling at any time without giving a reason;
- choose not to answer questions that feel uncomfortable;
- ask questions about the methods used and the counselling process;
- express disagreement or concerns about the approaches being used.
5. CONFIDENTIALITY
All information obtained during counselling is strictly confidential and will not be disclosed to third parties without the client’s written consent.
Exceptions (in accordance with Ukrainian law):
- a real and immediate threat to the life or safety of the client or another person;
- signs of abuse involving a minor;
- a court order or a request from law enforcement authorities.
The client will be informed in advance in such cases, unless doing so would conflict with safety requirements.
6. RECORD-KEEPING
The psychologist may keep brief working notes for personal professional use. These are stored securely and are not accessible to third parties. Audio or video recording of sessions is permitted only with the client’s written consent.
7. LIMITS OF PSYCHOLOGICAL SUPPORT
Psychological counselling is not a medical service and does not replace psychiatric treatment or medication. If symptoms arise that require medical attention, the psychologist may recommend consulting an appropriate healthcare professional.
8. PROCESSING OF PERSONAL DATA
In accordance with the Law of Ukraine “On Personal Data Protection” dated 01 June 2010 No. 2297-VI, by signing this document, the client consents to:
- the collection and processing of personal data (full name, contact details and information provided during counselling) for the purpose of organising and providing psychological consultations;
- the storage of data in a secure form for as long as necessary to fulfil the stated purpose;
- the use of contact details for communication regarding bookings, confirmations or rescheduling of sessions.
The client has the right to: obtain information about their personal data, request its correction or deletion, and withdraw consent to processing at any time by sending a request to yopsihology@gmail.com.
Personal data are not shared with third parties, used for advertising or commercial purposes, or made publicly available.
9. CONSENT
I, the undersigned, confirm that:
- I have read this document and received answers to all my questions;
- I understand the terms, format and limits of psychological work;
- I have read and understood the payment terms and cancellation policy;
- I consent to the processing of my personal data for the purposes stated above;
- I give my voluntary informed consent to receive psychological services from Yuliia Serhiivna Kotliarevska.