Student Counselling Service working agreement

Having registered with the Student Counselling Service (SCS), 

I agree to give 48 hours’ notice where possible should I wish to cancel any appointments or group sessions offered by contacting the office by phone +44 (0)117 394 0123 or email: student-counselling@bristol.ac.uk. 

I understand that: 

• I can work together with SCS staff in choosing individual counselling, group therapy or Mental Health Advisory Service support and reviewing what is appropriate to my needs. 
• SCS provides short term therapeutic interventions. For One At A Time sessions, I can access support until the end of the academic year. SCS will complete reviews at six sessions and signpost me if necessary to appropriate services. 
• To book a further One At A Time appointment I should first reflect on the session. If I require further support, I need to wait a minimum of 24 hours to make an appointment. 
• SCS works according to the British Association for Counselling and Psychotherapy’s Ethical Framework. 
• SCS will always contact me if for any reason my session needs to be cancelled or re-arranged. 
• If I have any concerns about the counselling, I have received I should raise this with my counsellor/mental health adviser or group facilitator in the first instance and then, if necessary, with the Head of Service by email to student-counselling@bristol.ac.uk 
• If I am offered a block of six regular sessions, once I have agreed to an appointment time, I may lose an appointment if I do not give 48 hours’ notice to the service. 

Consent form

I confirm that I have read and understood the ‘SCS Confidentiality and Data Protection Statement’. 

I confirm that I give the Student Counselling Service my consent to liaise (share information about me) with the following services if necessary, on a confidential basis, for my time at university. I understand that I can withdraw my consent at any time. 

Student’s Health Service/or my GP: Yes / No 

Student facing services in Education and Student Experience division (Student Wellbeing Service, SHERPA, Disability Services, Multifaith Chaplaincy, Residential Life Service, Students’ Health Service and the Student Inclusion Service): Yes / No 

Sports Exercise and Health (for Healthy Minds programme): Yes / No 

Emergency contact 

When you registered for your studies, and then at the start of each academic year, you were asked to let the University know if we can contact a designated person should we have serious concerns about your wellbeing. 

Did you consent for your emergency contact (Opt-in) to be used in a mental health crisis? Yes / No / Unsure 

To update your emergency contact you must log into your Student Info. 

Please let us know if you consent to information being shared with an emergency contact. Please add a date to any information you add or any updates you make. 

Academic Department (i.e. for extenuating circumstances or welfare issues): Yes / No 

Other appropriate professionals within and outside the university on a confidential basis, such as NHS mental health teams, SU-advice centre, 3rd sector services, or any others that may arise: Yes / No 

Please add any names of individuals that are supporting you, or any further information around consent: 

I give consent for SCS to send me text message reminders about booked sessions: Yes / No 

I understand that there are limitations to privacy and confidentiality due to statutory duties where the law requires disclosure if there is imminent risk of harm to self and others (to protect my vital interests or those of another person) or in the event of serious illegal activities. 

Print student full name 

Sign by student

Date 

Sign by counsellor

Date 

Print counsellor full name