• UNITED MINDS COMMUNITY SERVICES

    Assessment Consent Form

  • Psychological Services

    As part of providing a psychological service to you, the psychologist will need to collect and record personal information from you that is relevant to your current situation. This information will be a necessary part of the assessment and any subsequent diagnosis. You do not have to give all your personal information, but if you don’t, this may mean we may not be able to provide you with a service.

     

    Your Information

    The information is gathered as part of the assessment, diagnosis and treatment of your condition and is seen only by the psychologist. The information is retained in order to document what happens during sessions and enables the psychologist to provide a relevant and informed service. At any stage you as a client are entitled to access the information about you kept on file, unless the relevant legislation provides otherwise. The psychologist may discuss with you, appropriate forms of access. Our full privacy policy can be found at www.unitedminds.org.au/client-area. 

     

    Confidentiality and Exchanging Information

    All personal information gathered by the psychologist during the provision of the psychological service will remain confidential and secure except where:

    1. It is subpoenaed by a court, or

    2. Failure to disclose the information would place you or another person at serious and    

        imminent risk; or

    3. Your prior approval has been obtained to


               a) provide a written report to another professional or agency (e.g., a GP or a lawyer); or

               b) discuss the material with another person (e.g., a parent or employer; or if disclosure

                   is otherwise required or authorised by law)

    4. All provisional psychologists at the clinic discuss their case load with an experienced psychologist in a supervisory relationship. Information on the nature of the case is shared with the provisional psychologist’s supervisor.

    5. Registered psychologists will also discuss client presentations in regular supervision to ensure best practice. We only discuss non-identifiable information in the course of supervision.

     

    Fees

    Please refer to your personalised quote that was provided prior to beginning the assessment. This will have a detailed breakdown of all sessions and associated fees for your specific assessment. 

     

    Cancellation Policy

    You will receive an SMS reminder 72 hours prior to your scheduled appointment.  If you need to cancel or reschedule appointment, you are required to provide at least 48 hours notice.  Otherwise, an out of pocket fee of 50% of the session fee will apply which is not covered by Medicare. This fee can be waived in exceptional circumstances at the discretion of the Psychologist and managing director. Our full cancellation policy can be found at www.unitedminds.org.au/client-area. 

     

    Consent

    I have read and understood the above consent form and I agree to these conditions for the service.

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  • UNITED MINDS COMMUNITY SERVICES

    Assessment Authority to Obtain and Release Information

  • United Minds Community Services Assessment Division understands the imporance of gathering information from multiple sources to inform assessment decisions. In order to provide you with an accurate assessment we may need to talk to and gather information from other service providers, teachers, parents, government bodies or other persons. The information obtained and released will pertain to your assessment or to information that will assist the Psychologist in the process of assessment and diagnosis.  You can withdraw this consent to send/receive information at any time by verbal or written request with your treating psychologist.

     

    By signing this form, I agree to give United Minds Community Services permission to obtain and release information about/for my treatment/assessment with: 

     

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