Consent and Confidentiality

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Name* This field is required.
First Name
Last Name
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Confidentiality Policy* This field is required.What you share with your counsellor is private. Only your counsellor and their supervisor see your information. We won't share it unless you give us written permission. When We Must Share (No Permission Needed) We have to share information if: A court orders it. It's to prevent serious harm to you or someone else. Someone talks about sexual offenses against a child (under 16, or under 18 with certain disabilities) – we must report this. When We Might Ask to Share (Your Choice) Sometimes, we'll ask if we can share info (like with your doctor or a family member) to give you the best care. You can always say no. If you say no, it might affect the services we can offer. Our Standards Our counsellors follow strict professional rules from the ACA and PACFA. You can find their standards online: ACA Standards PACFA Standards Do you agree to this Confidentiality Policy?
Yes
No
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Emergency and After-Hours Coverage* This field is required.‘Dr Patrick Pheasant – Counselling, Coaching & Consulting’ is not a crisis centre. If you are concerned about your personal safety or the safety of others please call 000 for emergency services or go to your closest hospital’s emergency department. If you are an existing patient of Dr Patrick Pheasant and are unable to contact him the following options are available until he is able to respond to you: Call 000 for an ambulance if you or someone else is suicidal or in danger Call 000 for the police if the situation is violent Lifeline – 13 11 14 NSW Domestic Violence Line – 1800 656 463 Mental Health Line – 1800 011 511 QLife counselling and referral service for LGBTIQ+ individuals – 1800 184 527 (3pm to midnight daily) Kids HelpLine (5-25yrs) – 1800 551 800 You are encouraged to share any experienced after-hours emergencies as soon as possible with your counsellor/provider. Do you agree to this Emergency and After-Hours Coverage?
Yes
No
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Our Use of Artificial Intelligence (AI)* This field is required.At Dr Patrick Pheasant Counselling, we may use carefully selected Artificial Intelligence (AI) tools to help with administrative tasks and to support your counsellor's professional development. Here's what our use of AI means for you: Humans are in Charge: AI will never replace your counsellor's professional judgment or provide direct therapeutic advice. Your counsellor always makes the decisions. Your Privacy is Protected: We will not put your confidential information, personal notes, or anything directly identifiable into public or general-purpose AI tools. All AI use strictly follows Australian privacy laws, including the Australian Privacy Principles (APPs). No AI Diagnosis: AI won't diagnose you or decide your treatment. These are complex human processes. Transparency: If we use AI in a way that directly involves your individual session or personal data (like for recording and transcribing your sessions), we will always inform you clearly and get your explicit consent beforehand. We use AI responsibly to enhance our service, not to compromise your trust or privacy. Have questions? Just ask your counsellor or our team. Do you agree to this use of Artificial Intelligence (AI)?
Yes
No
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Cancellation Policy* This field is required.We understand that unforeseen circumstances sometimes arise. If you need to cancel your counselling appointment, please do so with at least 48 hours' notice. Cancellations made more than 48 hours in advance will be rescheduled without penalty. Cancellations made within 48 hours of your appointment will incur a 50% fee of the session cost. Missed appointments without notification will be charged the full session cost. Rescheduling: We will do our best to accommodate your desired rescheduled appointment time. This policy helps us ensure that cancelled appointments can be offered to other clients in need. We appreciate your understanding and cooperation. To cancel your appointment, please text at 0434881060 or email us at contact@patrickpheasant.com.au. Do you agree to this Cancellation Policy?
Yes
No
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Email* This field is required.
example@example.com
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Mobile Number* This field is required.
04XX XXX XXX
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