When you come to the service, you will have the opportunity to discuss your difficulties with us. However, we have found that it helps us to have some preliminary information which we ask you to provide by filling in this form. It would be a help to us – and will mean more time for you to talk about your immediate problems with the therapist – if you could send it back to us when you confirm your appointment. If this is not possible, please bring it with you when you come to see the doctor.

Confidentiality

Anything you write to us, or that is written about you by us, will be kept completely confidential and will normally only be seen by the staff directly involved with the University Clinic. However, you may want to note the following.

Should you convince a member of staff that you intend to cause serious harm to another person, the member of staff may be legally required to disclose your intention to the relevant authorities if you are unwilling to do so yourself. This will never be done without your knowledge.

Members of staff in the clinic do undertake research. Occasionally this may mean that a member of the clinic staff wishes to include you in a research project. If so, you will be given information about the project and asked for your written consent. If you refuse, it will not affect your treatment in any way.