Data protection, info sharing, GDPR
Data Protection & Privacy Statement (Compliant with GDPR)
To comply with GDPR regulations, I request that this form is only completed once your deposit, full session, or therapy package has been paid. This prevents me from collecting personal information that is not required in advance.
This statement explains what personal data I collect, why I collect it, how it is stored, who it may be shared with, and how long it will be retained.
1. Data Collected and Purpose
Name and Age – Basic identifying information to support the therapeutic relationship.
Address, Email Address, and Telephone Number – Used to contact you regarding appointments or therapeutic matters. I will primarily use your preferred method of contact as indicated on your form. If I cannot reach you by that method, I may try an alternative.
Next of Kin and/or Medical Professional Details – Retained for use only if I have concerns for your safety. If I need to make contact, I will inform you whenever possible.
Session Notes – Brief notes are recorded to support continuity of care and to provide accurate information should it be required by medical professionals.
2. Sharing of Data
Your personal data will not be sold, shared for marketing purposes, or used unethically.
Data may be shared only under the following circumstances:
If required by law (e.g., court subpoena).
If there is a serious risk of harm to yourself or others.
If safeguarding concerns are disclosed (child, elder, or dependent adult abuse).
During professional supervision, where only your first name is used to protect anonymity.
3. Data Storage
Hard copy records are kept securely in a locked filing cabinet.
After therapy is concluded, records are transferred to a password-protected computer using your initials for identification.
Your phone number(s) may be stored on a business mobile phone under your first name and last initial.
Access to all data is restricted to the therapist only.
4. Data Retention and Disposal
Your personal details and session notes will be stored for the duration required by my professional insurer.
After this period, all personal information will be securely destroyed, and your contact number will be deleted from my mobile phone.
5. Consent
By signing below, you acknowledge that you understand how your data will be collected, stored, used, and disposed of, and that you consent to the processing of your personal information as set out above.
Therapist Signature: Nathalie Crittenden-Lopis
Your Therapy and Wellbeing
Client Signature: _______________________________
Date: _____________________
Client Initials (for consent): _______
