St Peters House Intake Form

Please read the terms and conditions and then fill in the form below to engage in counselling at St Peters House

Counselling Terms & Conditions
 
 
Confidentiality
What you say in counselling is confidential to this agency.  This means:

• Your information, including what is said in counselling, will not be shared with anyone outside of St Peters House without your permission.  
• Case information or notes may be reviewed by our Team Leader, during supervision, or by an external auditor, however to maintain confidentiality we only use first names and limit the information shared.
• All records are held securely on these premises.  Your session notes can be made available for you to read and we can provide you with copies if requested.
• We ensure all online sessions are secure and the environment in which we hold the session maintains your confidentiality.

Exceptions to Confidentiality

• If your counsellor considers there is a risk to your safety, the safety of others, property is threatened, or children are at risk of harm, then the counsellor will need to let the relevant people know to ensure the safety of those at risk.  Whenever possible this will be discussed with you first.

Sessions at St Peters House

• St Peters House is a short term counselling centre and offers sessions in person, via zoom or phone.
• Your first 6 sessions are subsidised, so we can offer them to you free of charge. The cost of providing our service is substantial, so we encourage you to consider making a financial contribution for all sessions if you are able.
• Each session lasts 50 minutes to 1 hour.  
• It is not our practice to have children in counselling sessions however exceptions can be made e.g. for breastfed babies, please discuss this with your counsellor.
• We will work together to establish goals that relate to the main issues you have come to counselling about. 
  • These will be reviewed throughout your counselling, on session 6 and/or when completing counselling.
  • If further counselling is required, you may have an additional 1-4 sessions. A fee applies for these additional sessions (please see the table on the back of this sheet).

Cancelling & Rescheduling Appointments

• ​Your appointments will be scheduled and a reminder text message sent the day before your appointment.  Please respond promptly to reminder texts to confirm your appointments.
• If you’re unable to keep an appointment please give at least 24 hours’ notice by phone or text on: 571 5916  or  022 045 6087. 
  (Please note our reception hours are 8:30 – 3pm, Tuesday – Friday)
• We offer zoom or phone appointments if you cannot make it in person for any reason.
• Only 2 missed appointments will be accepted.  A 3rd missed appointment or cancellation may end your counselling with us.
• You may discontinue counselling at any time (however, we would appreciate an opportunity to evaluate and review your counselling experience prior to this).

Counsellor Ethics

• Counsellors at St Peters House follow the ethical guidelines of, and are accountable to, either the New Zealand Association of Counsellors (NZAC) or New Zealand Christian Counsellors Association (NZCCA).  These guidelines are available online or a copy can be made available to read at St Peters House.
• Counsellors receive regular external supervision as part of their ethical guideline. 

Complaints

• St Peters House staff are expected to act in an ethical way at all times.  If you are unhappy with the way you have been treated by your counsellor and you wish to make a complaint, please talk to the Team Leader, Denise Coy or Manager, Cath Page.

Payment Guideline After 6 Free Sessions

​Weekly Household Income	Payment Per Session
​Beneficiary	$5
​Up to $500	$10
​$500 - $700	​$15
$700 - $1,000	$20
​$1,000 - $1,200	$30
​$1,200 and above	$50

Payments can be made in cash or with eftpos at reception or by Internet Banking.
St Peters Care & Counselling Charitable Trust
Bank Account 01-0434-0365728-000
Please use as references Counselling, your name, and your counsellor’s name. 
This allows us to allocate the payments you have made correctly.