• New Client Informed Consent:

    Psychologist
  • Format: (000) 000-0000.
  • How did you hear about the Trauma Centre?
  • Emergency Contact Details

  • Format: (000) 000-0000.
  • Informed Consent

  • Heal For Life Foundation needs to collect information about you for the primary purpose of providing a quality service to you. In order to thoroughly assess, diagnose and provide therapy.

    This information will also be used for:

    a. The administrative purpose of running the practice.

    b. Use within the practice if discussing or passing your case to another practitioner within the practice for your ongoing management.

    c. Disclosure of information to your doctors, other health professionals or to

    teachers to facilitate communication and best possible care for you; and

    d. Mandatory reporting.

    Heal For Life Foundation has a Privacy Policy that is available on request. This policy provides guidelines on the collection, use, disclosure and security of your information. The Privacy Policy contains information on how you may request access to, and correction of, your personal information and how you may complain about a breach of your privacy and how we will deal with such a complaint.

    To ensure the process of quality treatment provision, information about your assessment results and progress may be given to your referring General Practitioner (GP) as per Medicare regulations. With your written consent information can be shared with other relevant service providers, who are involved in your management.

    Provision of Telehealth Service

    Telehealth services includes therapy sessions provided by video or phone call, with preference for video call as this is closest to in-person therapy sessions. Once a Telehealth session is scheduled the Heal For Life admin team will email clients a secure link specific to each of them. This link will change each time so we ask all clients to please use the most recent links emailed.

    When clients click on their unique link, they will be able to connect to their Telehealth session with their counsellor via the Telehealth platform (e.g. Zoom). Please note no specific software needs to be downloaded. For more information on this please see our telehealth policy.

    Psychology Fees

    Our Psychology sessions typically go for 50 minutes. The cost of the session is $156.65. Payment of $156.65 is required in full prior to your appointment. $96.65 is then claimable through Medicare by the client. Clinical Psychology sessions are at a cost of $201.85 with a Medicare rebate of $141.85.

    Cancellation Policy

    When appointments are booked the Psychologist reserves the whole hour for that person, when a client cancels without correct notice this can cause disruption within the business. If for some reason you need to cancel or postpone your session, please give at least 24 hours’ notice by way of calling the office, otherwise 50% of the full appointment fee will be charged. A full copy of our cancellation policy is available on request, can be found in the reception and is also located on our website.

    Consent, please click submit below to confirm you have understood and give consent to the following:

    o  I have read the above information and understand the reasons for the collection of my personal information and the ways in which the information may be used and disclosed, and I agree to that use and disclosure.

    o  I am aware that I can access my personal and treatment information on request and if necessary, correct information that I believe to be inaccurate.

    o  I understand that if, in exceptional circumstances, access is denied for legitimate purposes, that the reasons for this and possible remedies will be made available to me.

     

  • Safety Agreement

  • As a Heal For Life client we value your safety and that of our psychologists. Please read and agree to the below.

    1.  What is discussed between me (the client) and my psychologist will be kept confidential. I accept that information will be shared to relevant parties only if my safety or that of someone I identify is at immediate risk.

    2.  If I have a history of drug or alcohol addiction I will make all reasonable efforts to be ‘clean’ before my appointments so I can experience my feelings, remain grounded, and have no possibility of suffering from withdrawals during my sessions.

    3.  Any sexualised behaviour, including jokes and innuendos, are not appropriate or acceptable.

    4.  I will behave in a safe manner to maintain the space as one that is free from any kind of verbal and/or physical abusive behaviour.

    5.  I am committed to being present in my sessions and to avoiding distractions. I understand that at this moment I am here for myself because I deserve care and the opportunity to be entirely myself.

    6.  I will be on time for my session to get the most out of my client/psychologist relationship.

    7.  I will only access my mobile phone should it be relevant to my session.

    8.  I understand that the psychologist is available during my session, and has limited availability outside of this between the office hours of 9.00am to 5.00pm.

    I understand and agree to uphold the key principles that make up this Safety Agreement. Any breach of this agreement may result in my being asked to leave. I have provided the name of an Emergency Contact Person you can contact in the event I am asked to leave.

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