As part of providing a psychoeducation service to you, Tegan McKay (Provisional Psychologist) needs to collect and record personal information from you that is relevant to your situation, such as the information filled out above. This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted. Disclosure of personal informationPersonal information gathered as part of this service will remain confidential except when:1. it is subpoenaed by a court; or
Provision of a telehealth serviceWhere appropriate the service may be provided by telephone or videoconferencing. You are responsible for the costs associated with setting up the technology needed so you can access telehealth services. Tegan McKay will be responsible for the cost of the call to you and the cost associated with the platform used to conduct telehealth services. To access telehealth consultations you will need access to a quiet, private space; and the appropriate device, i.e. smartphone, laptop, iPad, computer, with a camera, microphone and speakers; and a reliable broadband internet connection. The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology used. To support the security of your personal information this practice uses Power Diary Telehealth and/or Zoom, which is compliant with the Australian standards for online security and encryption. Limitations of telehealthA telehealth psychoeducation consultation may be subject to limitations such as an unstable network connection which may affect the quality of the therapy session. In addition, there may be some services for which telehealth is not appropriate or effective. Your practitioner will consider and discuss with you the appropriateness of ongoing telehealth sessions. I, First Name* Last Name* have read and understood the information in this Consent Form and have discussed any outstanding questions with the Provisional Psychologist. I agree to the above conditions for telehealth psychological psychoeducation services to be provided in accordance with AHPRA regulations.Client signature Signature* Date*