Definition

A telehealth service is a therapy service that is conducted via the telephone or secure video platform, such as ZOOM. The purpose of the session may include but is not limited to counselling, assessment, supportive intervention and onward referral.

Instructions

Please read this form carefully in order to provide your informed consent for undertaking telehealth consultations with SAFE & SOUND COUNSELLING If you have any questions, please discuss them with SAFE & SOUND COUNSELLING prior to the session.

Telehealth Consultation Consent

1.       I understand that there are laws that protect my privacy and the confidentiality of my personal information apply to telehealth sessions.

2.       I understand that my practitioner has chosen a telehealth software platform which meets the recommended standards to protect the privacy and security of the consultation.

3.       I understand that there are potential risks and consequences of participating in telehealth consultations, including technical difficulties such as internet connection limits.

4.       I understand that telehealth consultations will not be exactly the same as a direct visit due to the fact that I will not be in the same room as my healthcare provider.

5.       I agree that neither myself nor my practitioner will record the sessions without explicit permission from both parties.

6.       I understand that telehealth consultations do not provide emergency services. If I am experiencing an emergency, I understand that I can call 000 or Lifeline (13 11 14) for crisis and suicide support.

As part of the provision of service to you, including but not limited to counselling, assessment, treatment and report writing, SAFE & SOUND COUNSELLING needs to collect and record personal information from you. In accordance with relevant privacy and confidentiality legislation, the information collected may include (but may not be limited to) your name, contact details, medical history, employment status and other relevant information as appropriate.

The collection of this information is a necessary part of your participation in COUNSELLING / THERAPY/COACHING. Your informed consent must be given prior to commencement of services.

Privacy and Confidentiality

Your personal information is gathered as part of the service you are engaging in. Information is securely stored and is retained in order to document what occurs during sessions. This helps the COUNSELLOR to provide a tailored service specific to your needs.

Limits to Confidentiality

All personal information gathered by SAFE & SOUND COUNSELLING during the provision of services remains confidential except when:

1.       It is subpoenaed by a court; or

2.       Failure to disclose the information would, in the reasonable belief of SAFE & SOUND COUNSELLING place you or another person at serious risk to life,health or safety; or

3.       Your prior approval has been obtained to

a)       provide a written report to another professional or agency;

b)       discuss the material with another person;

c)       disclose the information in another way; or

4.       You would reasonably expect your personal information to be disclosed to another professional or agency (e.g. your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected; or

5.       Disclosure is otherwise required or authorised by law.

Consequence of Not Providing Personal Information

If you do not wish for your personal information to be collected in a way anticipated by this consent form, SAFE & SOUND COUNSELLING may not be in a position to provide the COUNSELLING service to you.