• Victims Services Clients - Intake and Agreement

    The Counselling Wollongong Studio | One-to-one counselling

  • Welcome. This form is for one-to-one counselling funded by NSW Victims Services. It helps us consider your request for a booking. Sending it does not confirm an appointment. We first check your approval, available funding, suitability and appointment availability.

    You do not need to describe traumatic events in detail. You can ask to discuss sensitive information privately. Please do not include payment-card details or upload identity documents. This form is not monitored for emergencies. If someone is in immediate danger, call 000.

    The service is provided by Isaac Bailey, RCS-Health trading as The Counselling Wollongong Studio (ABN 61 529 395 719). We collect your details to assess your request, contact you safely, provide counselling and meet relevant Victims Services requirements. Jotform handles this form. The agreement below explains privacy, service providers, reports and your choices.

  • How can we contact you safely?*
  • If you give a safe phone number, may we leave a voicemail?
  • Where would you prefer to meet?

  • 1. Your privacy

    What you tell your counsellor is private. Relevant information may be shared with your consent, or when the law requires or allows it - for example, child-protection duties, serious safety risks or lawful court requirements.

    Telling us about domestic, family or sexual violence does not automatically mean everything is reported to police. Where safe and lawful, we will explain what needs to be shared and why.

    Your counsellor uses professional supervision, removing identifying details where practical. Identifiable sharing needs a lawful basis.

    This agreement does not give blanket permission to release your whole file or waive legal protections for counselling records.

  • Do you understand privacy and its limits?*

  • 2. Your Victims Services funding

    Before funded counselling starts, we must confirm your approval, your counsellor’s assignment and enough approved hours. This form does not approve funding.

    We will explain how your hours are used; hours are not the same as appointment numbers. Extra hours need your consent and Victims Services approval first. Case-management work can use hours only with the required approval and consent.

    We share relevant information with Victims Services for assignment, funding requests, claims and required reports. A final report is required when counselling ends or after more than six months without attendance or contact. We will explain relevant reporting.

    You can ask for copies of reports and change counsellor at any time without giving a reason. Only one counsellor can be assigned at a time.

  • Do you understand the funding checks and required information sharing?*

  • 3. Appointments and cancellations

    Appointments are normally 50 minutes. We record the actual funded session time.

    Tell us as early as possible if you need to cancel or change an appointment. Victims Services treats an appointment as missed when you do not attend and have not given more than one business day’s notice. Ask us how this applies to your appointment.

    You will not be charged a missed-appointment fee for this funded counselling. The scheme may pay for up to two missed appointments per claim, subject to its rules.

    Two missed appointments do not automatically end counselling. We will discuss ongoing arrangements with you; further missed appointments do not become a private cancellation debt.

  • Do you understand the funded appointment and cancellation arrangements?*

  • 4. Records and AI tools

    Jotform hosts this form. Zoom supports online sessions. NovoNote listens to sessions, transcribes them and creates draft notes for your counsellor to review and edit. Transcripts are deleted after the notes are finalised; clinical notes remain in your record.

    The practice also uses AI in Microsoft software and OpenAI to draft counselling plans, psychoeducation and other counselling materials. Model training is turned off for its OpenAI use.

    Providers process information relevant to their role. Some processing may occur outside Australia. Ask about what information is used, where it goes and how it is handled before deciding. Privacy information: https://counsellingwollongong.au/privacy

    The practice requires consent to the described AI use before counselling can proceed. You can ask questions or choose not to consent. Those choices need discussion before counselling starts; submitting this form does not arrange a non-AI service.

  • What is your decision about the described NovoNote and AI use?*

  • 5. Your choices, rights and online sessions

    You choose what to discuss and can ask questions, pause or end counselling. No particular outcome is promised.

    You can ask to access or correct your information, request communication support, raise a concern or complain. Any lawful access limits will be explained. You do not have to complain to your counsellor before using independent complaint options.

    For Zoom sessions, choose a private place where possible; tell us if privacy is difficult. Agree your current location and a connection-loss or urgent-safety plan with your counsellor. Routine telephone counselling is not offered.

    This form is not an emergency service. Call 000 if there is immediate danger.

    Privacy information: https://counsellingwollongong.au/privacy
    Questions: https://counsellingwollongong.au/enquire
    Practice complaints form: https://form.jotform.com/263003752219047

  • Do you understand your rights and the online-session arrangements?*

  • 6. Your decision

    Please ask about anything that is unclear. Agreeing does not waive your legal rights or authorise unrelated sharing. Funding approval is separate from consent to counselling.

    You can send questions without signing or agreeing. Any questions or unresolved consent choices need discussion before counselling starts. Choosing agreement below does not override an earlier request for explanation or a decision not to consent.

  • What is your decision about this counselling agreement?*
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