CONTRACT FOR PSYCHOLOGICAL ASSESSMENT AND TREATMENT

This agreement is made the …………… day of ……………….. two thousand and fourteen between Psychological Systems Limited (“the Psychologist”) of the first part and ……………….  ……………………… (“the Client”) of the second part and concerns the provision by the Psychologist of an analytical service and subsequent treatment to and of the Client.  The Client signifies his or her acceptance of the terms of this agreement by supplying his or her unique sign-in information which shall become part of this document.

1.  In consideration of payment of the prescribed fee by the Client to the Psychologist (receipt of which is hereby acknowledged) the Psychologist will:
  • a) Interview the Client and take a clinical note (including by the use of electronic recording means) of whatever problems or difficulties revealed by the Client.
  • b) Provide a psychometric questionnaire (“the Questionnaire”) to the Client for him or her to complete in the prescribed manner.
  • c) Analyse the answers given by the Client to the Questionnaire.
  • c) Based on the said answers given, provide an assessment of the Client to the Client and only with his or her specific agreement in writing to any third party specifically named by the Client.
  • d) Recommend to the Client a course of treatment for any psychological malfunction as identified by the Psychologist.
  • e) Provide at an additional fee to be agreed any treatment recommended to and accepted by the Client.
  • f) Help and support the Client in every step of the procedure and any treatment administered.
  • g) Provide at an additional fee to be agreed training for and of the Client in any way necessary to give effect to any recommended treatment.
  • h) Subject to clause 3 below, maintain strict confidentiality of the answers to the Questionnaire and of the analysis therefrom (whether oral or in writing) such that all material relating to the Client  remains jointly and severally strictly within the intellectual property possession of the  Client and the Psychologist or their servants and will not be divulged to any third party except as provided by sub-Clause d above..
2.   In return the Client agrees :
  • a) To commit him- or herself to the programme and to take an active role in helping to develop emotional well-being within him- or herself.
  • b) To provide answers to the Questionnaire which are detailed, accurate and truthful.
  • c) To follow such advice as is given by the Psychologist.
  • d) To maintain the decision and the will to get better by allowing any improvement to flourish in the knowledge that psychological health and happiness are deserved.
  • e) To pay any additional fee or fees as are mentioned in Clauses 1f and 1h above.

3.   Notwithstanding the provision of Clause 1.i. above it is agreed between the parties hereto that the answers to the Questionnaire and any conclusions derived therefrom may be retained by the Psychologist (and Richard Conan Sherry in particular) and be used exclusively by each of them only for research purposes.

 4.   In addition the Client agrees that he/she understands that:
  • a) Answering the said Questionnaire or any of its diverse derivative occupational forms whether in part or in whole is a voluntary act taken by the Client and that the Client is free to seek external advice on whether or not to do so either before or during giving the answers.
  • b) Answering the Questionnaire and the following of any treatment recommended as a result requires a clear understanding of his or her obligations under the terms of this contract.

5.   Disclaimer.   It is further agreed that neither the creator of the Questionnaire (Richard Conan Sherry) nor Psychological Systems Limited  nor their servants or agents will be liable for any loss injury or damage whatsoever and howsoever caused to any individual or partnership or corporation arising from the giving or the use of the answers to the Questionnaire nor for any loss injury or damage whether mental financial or material or in any other way occasioned by the application by any person or partnership or corporation (whether a party to this agreement or not) of the analysis of the answers to the Questionnaire or the learning content or the outcome from this psychological material.

6.   Jurisdiction.  It is further agreed that the law applying to this agreement shall be the law of England and Wales and it shall be in the courts only of that jurisdiction that any dispute arising out of this agreement shall be justicable

Signed by the parties hereto on the day and date first above mentioned by:

Richard Conan Sherry for and on behalf of
Psychological Systems Limited and himself  .............................................................. .......................................................................(the Client) .............................................

I am accepting Disclaimer Agreement and Terms & Conditions