Workers Compensation/CTP Referral

This Online Telehealth Consent Form is required in addition to the ‘Consent Form’ and outlines the terms of online and phone therapy.

Telehealth services are not suitable for all clients, and this will be discussed with you by your psychologist. Alternatives to receiving online therapy services will be discussed if required and available.  

Online Therapy Sessions

Once a telehealth session is scheduled, an email will be distributed to your email with instructions on how to connect to your session via the secure online platform. Clients are required to download and use the free Zoom app/software.

Zoom can be used with Windows, Mac, and on tablet and mobile devices. Your psychologist can help you with instructions for downloading Zoom to your device.

Recording of Telehealth Sessions

Telehealth sessions will not be recorded by your psychologist, and all clients are asked to respect the privacy of their psychologist by agreeing not to make recordings of therapy sessions and not to use materials from therapy sessions for purposes other than therapy (e.g., posting any portion of sessions on internet websites and/or social media is not permitted). 

Procedures in Case of Technical Difficulties or Disruptions in Service

In the event of technical difficulties or disruptions, an attempt to resolve the difficulties will occur in the first instance, clients will be contacted by phone if reconnection is not possible within 5 minutes to discuss whether to continue or reschedule the telehealth session.

Privacy

While every effort will be made to keep all information confidential, the privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology. Clients are responsible for understanding the potential risks of confidentiality being breached through unencrypted email, in transit by hackers or internet service providers, lack of password protection or leaving information on a public access computer. 

Safeguards and Client Responsibilities

Clients are responsible for creating and using additional safeguards with devices used to access for our services, particularly when their devices are shared or may be accessed by others. Responsibilities includes creating complex passwords for devices, keeping all passwords secret, ensuring all email and online therapy sessions are exited properly and maintaining security of their wireless internet access points. For more information clients are encouraged to read cybersecurity resources provided by the Australian Cyber Security Centre.

Getting the most out of your Telehealth Service

Clients will need to have a secure WIFI or internet connection, a working webcam and audio on their device. 

Please Note: Clients are responsible for any costs incurred during the telehealth session, including data usage and equipment or software.

Clients would benefit and as such are greatly encouraged from choosing an environment for their telehealth session where there is minimal noise interference, and where they are least likely to be overheard by others or interrupted.

Please Note: Misunderstandings may occur due to connection problems causing delays or less than optimal audio and image quality. Clients would benefit from approaching misunderstandings with patience and clarifying any potential misunderstandings with their psychologist.

Medicare Requirements

The client is referred by a GP (or Psychiatrist) with a valid and active mental health treatment plan and referral letter; and the client is not an admitted patient in hospital

At the advice of the APS, clients receiving telehealth services should provide the names of at least two local emergency contacts, before beginning their first online therapy session. This will allow the psychologist to make necessary arrangements in the event of an emergency.

For more information regarding telehealth services, clients are encouraged to read the Fact Sheet provided by the APS via this link.

By agreeing to participate in telehealth sessions, I agree to expressly release Anima Hub from any liability associated with unintended cyber security issues and/or difficulties with unsecured communication.

 

Nature and purpose of the Psychological Service

As part of providing a psychological service including assessments and counselling to you, Anima Hub will need to collect and record personal information pertaining to you. This information is a necessary part of the psychological assessment and treatment that is conducted.

Psychological therapy may vary and depend on the issues brought forward. Psychological therapy calls for a very active effort on the client behalf. For the therapy to be most successful, you (the client) will have to work on things we talk about both during our sessions and at home.

Initial sessions will involve an evaluation of your needs. By the end of the evaluation, the therapist will be able to offer you a treatment plan to follow. Should you have any questions during therapy feel free to discuss these. You (the client) can cease therapy with the therapist at any time. You may wish to pursue another treating practitioner; your therapist will make every endeavour to ensure this is facilitated.

Access to your information 

As part of providing psychological services, relevant personal information to the current situation will be collected and recorded. The information will assist in providing an appropriate and thorough service. Information will be stored in a secure location for a minimum of 7 years, or if you (the client) are under the age of 18 at the time of treatment, until you are 25 years of age. You may access the information in your file on request, subject to the exceptions in the National Privacy Principles.

Confidentiality and Privacy

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

1. It is subpoenaed by a court, or disclosure is required or authorised by law; or
2. Failure to disclose the information would place you or another person at risk of harm; or
3. Given your prior approval, or consent of a parent or guardian who is legally authorised to act on your behalf in order to provide a written report to another professional or agency, or discuss information with another person e.g., parent or employer; or
4. You would reasonably expect your personal information to be disclosed to another professional or agency and disclosure is directly related to the primary purpose for which it was collected such as to inform your GP of treatment and progress; or
5. Clinical consultation with another professional is required to provide better clinical services (identifying details will remain confidential).

If during the course of your work with Anima Hub, he becomes aware of risk to someone’s life, health, or wellbeing, he is required by policy of the state and federal governments to report the matter to the appropriate agencies.

Session Fees

Please note fees for worker's compensation claimants are in accordance with SIRA pre-established fees. These are subject to change in accordance with SIRA regulatory requirements.

Cancellation Policy

If for some reason you need to cancel or postpone your appointment, please give at least notice 24 hours notice. Under section 60(3) of the 1987 Act, payments are to be made as costs are incurred, but only if properly verified, meaning a fee must not be charged where a worker cancels or does not attend scheduled treatment services. Therefore, should ongoing cancellations or no shows be noted during the course of treatment, Anima Hub holds the right to recommend other treatment providers. Whenever possible, please make every effort to notify the practitioner. To cancel or rearrange an appointment, please call Anima Hub on 0426 926 171.

Emergency

In case of emergency, please go to the emergency department of the nearest hospital. For further information refer to the website for your local health district. For out of hours phone support, you may find it helpful to call Lifeline on 13 11 14. Please refer to animahub.au for more crisis lines.

 

I, {clientsName} have read and understood the above consent form provided by Anima Hub and have had the opportunity to have any questions I may have about it answered. I agree with the psychological service provided and the associated fee I am required to pay.
 
Exchange of Information Consent

All personal information gathered during the provision of psychological services will remain confidential and secure except when:

  1. Your prior approval has been obtained to:

1. Provide a written report to another professional or agency (e.g., a school, GP, solicitor, etc); or
2. Discuss the material with another person (e.g. a teacher, doctor, parent, etc); or

  2. Failure to disclose the information would place you and/or another person at risk; or

  3. It is subpoenaed by a Court In order to provide a comprehensive psychological service, it is sometimes necessary to exchange information about you with other people.

By signing this form, you give your psychologist permission to seek information about you, to release information about you, and/or to discuss your situation within the limits outlined below. The information exchanged assists your clinician to make a thorough assessment and treatment plan for you or may help other professionals provide services for you. You have a right to withdraw this consent at any time by telling your clinician or putting your request in writing.