Jacqui Olliver, Psycho-Sexual Relationship Consultant at End the Problem

Anxiety | Premature Ejaculation | Erectile Dysfunction | Unable to Orgasm | Low Libido | Vaginal Dryness


Mutual Non-Disclosure and Confidentiality Agreement

The treatment provider Jacqui Olliver from End the Problem, located at 15a Strathfield Lane, Whitford, Manukau, Auckland 2571, New Zealand adheres to the Privacy Act 1993, which is a law that governs how personal information is collected and used. It requires Jacqui Olliver to respect the privacy of personal information that she has access to. In practice this means:

1. All client information including emails, the confidential questionnaire and all case notes are contained in a password protected computer or in a locked cabinet. The information the client provides is recorded on a database, enabling Jacqui Olliver to gather statistics. This provides her with information about patterns of service use. When used for statistical and administrative purposes, no information is included that would identify individuals.

2. If anyone such as a spouse or partner phones or emails Jacqui Olliver, they will not be told that the client has been in contact with, or attended a session unless Jacqui Olliver has the client's express permission to do so.

3. The client may give Jacqui Olliver permission to share certain information with their partner, spouse, doctor, or for the purposes of referral to another health or wellness practitioner. This information given is kept to the minimum needed for the specific situation.

4. In addition to the Privacy Act, Jacqui Olliver is governed by professional codes of ethics. This means she will not disclose the client's personal information except in limited circumstances. No unnecessary personal information is provided. Information may be given without permission in the following circumstances:

1. Legal requirements: If Jacqui Olliver is compelled by law to disclose information.

2. Safety: If Jacqui Olliver believes that the client or someone else is at risk of serious and immediate harm, after consulting a professional colleague, she may disclose sufficient information to another person to enable them to assist the client or the person in danger.

Supervision
Jacqui Olliver may discuss cases with professional colleagues. In these situations, no names or other identifying information are used and any such consultants are bound by similar ethical and legal confidentiality requirements. The purpose of these discussions is to improve the quality of service to clients.

Protection of Service Provider Resources
All resources provided to the client during and after each session are to be used solely by the client and their partner (or spouse) to resolve their personal issues. All resources remain the intellectual property of Jacqui Olliver from End the Problem and may not be taught or shared verbally, digitally, printed or in any other format.

Declaration: By entering my personal details below, I agree to abide by the guidelines set out in this Mutual Confidentiality Agreement with Jacqui Olliver from End the Problem and in so doing, I understand that this contract is mutually binding for me and the above mentioned treatment provider.

Client Name:         

Address:               

Email address:      

Date:

Treatment Provider: Jacqui Olliver

Jacqui Olliver
Phone: +64 21 815 029 | Skype: jacqui.olliver
Email: [email protected]
Website: www.EndTheProblem.com

End The Problem
15a Strathfield Lane, Whitford
Manukau, Auckland 2571
New Zealand



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