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Report of Wrongdoing

If you are concerned that there has been an incident of Wrongdoing (as detailed in our Reporting of Wrongdoing Policy) and would like to raise this with us, please complete the form below. 

Please note: you can submit a report anonymously by not including your name or contact details – however, we would encourage you to complete them, if you feel able to, as this will help us to follow up on your concerns. You can supply the following information to us in writing, if you prefer. (Please send your report to the HGI Membership Secretary, Human Givens Institute, Chalvington, East Sussex, BN27 3TD, UK, marking the envelope ‘Private and Confidential’.)

We will acknowledge receipt of your Report of Wrongdoing within seven working days.

 
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Details of the person involved you wish to complain about

(if known)

Details of your complaint


Contact details of any witnesses to the incident

(Please provide these only if they have given their permission.)


If you ticked ‘Yes’, please note that the HGI Registration and Professional Standards Committee (RPSC) will need to contact the other organisation to establish whether the other organisation or the HGI is best placed to deal with the matter in the first instance. Do you give permission for the HGI to contact the other organisation?


Authorisation for release of case notes to enable complaint investigation

Please complete the section at the very end of this form to authorise the release to the Human Givens Institute of any case notes relevant to the matter about which you have made a complaint.

If you are including any documents with this form, please list them here. (If you are e-mailing this form, any documents should be attached with your completed form. Otherwise, paper copies can be posted to the address provided at the top of this form.)
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png rtf pdf doc docx.

I hereby confirm that:

  1. to the best of my knowledge, the information provided on this form is true and accurate; and
  2. I consent to the information I have provided being passed to the HGI Registration and Professional Standards Committee (RPSC) to assist it in reaching an informed decision regarding my complaint. Note: We will manage the information you provide in accordance with the provisions of the Data Protection Act (DPA) 1998: https://www.gov.uk/data-protection
Please type your name

Authorisation for release to Human Givens Institute of therapist’s case notes

hereby authorise the Registration and Professional Standards Committee (RPSC) of the Human Givens Institute (HGI) to receive copies of any case notes and forms relating to my counselling and all associated dealings as conducted by:


This form can be submitted anonymously, but if you wish to suppy your details please complete the fields below.

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