MHFA Wellness Hub - To Make an Appointment

MHFA Wellness Hub Psychology Clinic

Booking Enquiry Form and Consent
Disclaimer: Please note that our provisional psychologists/counsellors are contracted on a short-term basis (3-6 months) while they complete their clinical placement hours.

Please complete the enquiry form and review the consent agreement carefully. Your acknowledgement of this agreement is required to submit the form to ensure we provide appropriate support and care.

After submitting an enquiry, our admin team will be in contact within 5 business days to arrange a 50-minute Initial Assessment with a Provisional Clinician. This phone consultation is not a therapy session.

The MHFA Wellness Hub psychology clinic currently offers counselling services with provisional psychologists/counsellors at an affordable fee of $30 per 50-minute session plus Halaxy processing fee apply.

After this assessment, you will be allocated to a clinician, or provided with an external referral options.

Please note: Support letters are only provided after a minimum of 6 completed counselling sessions with the Wellness Hub.

If you have any queries, please email wellness.hub@mhfa.org.au or call 03 8825 3501.

The clinic operates Monday to Friday, 9:00am - 5:00pm (AEST/AEDT)
Who is this enquiry for?*

AdultChild (Under 18)
Are you a existing client or a new client?*

I'm a existing clientI’m a new client
Child's Full Name

First NameLast Name
Child's Date of birth*

DayMonthYear
Date
Child's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Next of Kin Full Name*

First NameLast Name
Parent / Next of Kin Phone Number*
Parent / Next of Kin Email*
School Name*

Muyan Primary SchoolOther (specify)
Preferred Location for Consultation*

Muyan Primary SchoolWellness Hub
Full Name*

First NameLast Name
Pronouns
Date of birth*

DayMonthYear
Date
Email*
Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select the state you are based in.
What type of clinician do you wish to see?*
Are you looking to complete any of the following assessments?
Please select up to three primary areas of focus you would like to consult with our clinician*

Anxiety, including phobias and social anxietyAttention Deficit Hyperactivity Disorder (ADHD)Autism Spectrum Disorders (ASD)Addiction or substance useAnger and mood/emotional regulation issuesBullying or Harassment (school / workplace)Carers WellbeingDepressionEating disordersFamily difficulties, separation or parenting concerns/stressGrief & lossInsomnia or sleep difficultiesLegal concernsLGBTQIA+ WellbeingLife transitions or adjustment issuesNDIS-related Mental Health NeedsRelationship, Family or Social ChallengesReligious, Cultural or Spiritual StrugglesSelf-esteem, wellbeing, resilience and self-worthSelf-harm or suicidal thoughtsStress and BurnoutTrauma / PTSDUniversity / school and education difficultiesWork- related issuesOther
Please select the type of counselling*

Individual CounsellingParent - Child CounsellingChild / Adolescent Counselling
Preference for in-clinic or telehealth sessions?*

In-personTelehealth
Preference for clinician gender? Please note this is subject to availability; it is not guaranteed that we can match you with a clinician of your preferred gender.

MaleFemaleOtherDoes not matter

Please indicate your availability during the week for the Initial Assessment. Please note we follow VIC time zone.

	Mon	Tue	Wed	Thu	Fri
9:00 - 9:50
10:00 - 10:50
11:00 - 11:50
12:00 - 12:50
13:00 - 13:50
14:00 - 14:50
15:00 - 15:50
16:00 - 16:50

How can we help you? (describe in 50 words)*

0/50
Emergency Contact
Primary Contact Name*

First NameLast Name
Email*
example@example.com
Phone
How did you hear about us?*

GP or referring DoctorWord of mouthSearch Engine (Google, Yahoo, Bing, etc)Recommended by friend/family/colleagueEmail promotionSocial mediaWebsiteReferred by a Support WorkerReferred by a School Wellbeing CoordinatorReferred by MHFA Support GroupsOther
(Optional) Please upload your GP referral/Mental Health Treatment Plan if you have one. (Note: sessions with counsellors/provisional psychologists are not eligible for Medicare claims.)

Cancelof

MHFA Integrated Wellness Hub Client Consent and Agreement Form
E: wellness.hub@mhfa.org.au
A: G1, 10 Yarra St, South Yarra VIC 3141
W: https://wellnesshub.mhfa.org.au/
Ph: 03 8825 3501

INTRODUCTION

The Mental Health Foundation Australia's (MHFA) Integrated Wellness Hub was established to provide low-cost psychological services to the Australian community. We are primarily a student clinic, and all work is conducted by provisional psychologists/counsellors on short-term clinical placements. While on placement, our clinicians are supervised by fully registered psychologists approved by the Psychology Board of Australia, who provide support, practical advice, and feedback. Moreover, our collaboration with specialist psychiatrists associated with the MHFA contributes significantly to maintaining a safe, ethical, and effective clinic governance, further enhancing the support available to our clients.

PRIVACY AND CONFIDENTIALITY

Psychological treatment is a highly personal experience, and it is important for the success of treatment that you have confidence in the responsible gathering and retention of your personal information and records.

As part of providing a psychological service to you, your therapist will need to collect and record personal information that is relevant to your current situation. Information is gathered as part of the assessment, diagnosis, and treatment of an individual and is managed by your treating clinician and associated supervisors and managers. The information is retained in order to document what happens during sessions and enables MHFA to provide a relevant and informed service.

All personal information collected during the provision of the therapeutic services will remain confidential and secure, except when:

There is legal obligation to disclose information, such as if a court subpoenas the clinician/clinic.
Failure to disclose the information would put you or another person at serious or imminent risk of harm.
Your prior approval has been obtained for the following:

a) Provide a written report to another professional or agency, for example, a general practitioner, a psychiatrist, a psychologist, a social worker, or a lawyer; or
b) Having another person, such as a family member or a person from the care team, in the session to discuss any pertinent situation to improve the conduct of treatment; or
c) If the disclosure is required or authorised by law.
Your right to privacy and confidentiality is fundamental. All sessions are confidential, and your information will remain private and secure. Exceptions happen if the client is in danger or putting others in danger.

FUNCTIONING OF THERAPY SESSIONS

At the Wellness Hub, we prioritise the confidentiality and effectiveness of our therapy sessions. To ensure a smooth and secure experience, we utilise Halaxy, a trusted practice management system. You can review the security measures implemented by Halaxy here: https://www.halaxy.com/article/security. Any changes to this system during your therapeutic journey at the Wellness Hub will be communicated to you in advance.

Before commencing therapy at the Wellness Hub, clients should be aware of the following:

Provisional Psychologists/Counsellors must have their practice periodically reviewed by a registered supervisor. As part of this process, sessions may be recorded as a tool to enhance the quality of services provided by our clinicians. This is done with the client's consent, and always in the interest of preserving client-therapist confidentiality. Recordings are not stored as part of the client's file, nor are they retained on any system for an extended period. They are also inaccessible to clients.

Both the clinician and client must be in a private setting with no others present in the room during sessions, unless mutually agreed otherwise. This applies for video/telehealth consultations as well.
Occasionally, unforeseen interruptions like phone calls, pets, or noises may occur during sessions. We ask for patience and understanding from both parties in such instances.
If joining via telehealth, it is the client's responsibility to access our service from a safe, quiet, and private environment. Ensure your device is rested on a flat surface, and there is a stable internet/phone signal connection.
ACCESSING YOUR CLIENT INFORMATION

Clients have the right to request for a copy of their notes under the Freedom of Information Act 1982 and the Health Records Act 2001, unless giving access would:

pose a serious threat to the physical or mental health of any individual,
jeopardise the privacy of others, and/or
hinder any law enforcement activities.
If you wish to view or have a copy of the materials recorded in your file, then it is necessary by law to make the request in writing and send it to:

Attention: [name of your treating therapist]
c/- Mental Health Foundation Australia Integrated Wellness Hub
G1, 10 Yarra Street South Yarra VIC 3141

MHFA may take up to 14 days for arrangements to be made.

INTEGRITY

MHFA recognises that the knowledge of the discipline of psychology, their professional standing, and the information they gather place them in a position of power and trust. All employees or representatives of MHFA exercise their power appropriately and honour this position of trust, keep faith with the nature and intentions of their professional relationships and act with probity and honesty in their conduct.

CLINICAL GOVERNANCE

The MHFA has clinical governance for therapy sessions based on best practices and principles under the guideline of the following associations: the Australian Psychological Society (APS), the Australian Counselling Association (ACA), the Australian Association of Social Workers (AASW), the Psychology of Board of Australia (PsyBA) and the Australian Healthcare Professionals (AHPRA).

HOURS OF OPERATION

The Wellness Hub operates Monday to Friday, 9:00am – 5:00pm (VIC time), and close on national and Victorian public holidays. The clinic does not provide crisis or afterhours services.

SCHEDULE OF SESSIONS AND DURATION

The standard session duration is 50 minutes. An agreement will be made between the client and clinician on the time and frequency of the sessions. Weekly or fortnightly sessions are recommended to maximise potential for therapeutic progress.

Clients have access to 6 initial sessions, after which clients may be given options to continue with the same clinician (subject to availability) or be provided with referral options. Please note if a client misses any of their 6 initial appointments, the clinician will do their best to offer additional sessions to make up for the missed sessions, however this may not always be possible if, for example, they are at the end of their placement.
FEES AND PAYMENTS

The consultation fee is $30 per 50-minute session with a provisional psychologist/counselling intern. Payments are made through credit card or direct debit payments. The MHFA does not accept cash payments or hold cash on its premises. For telehealth sessions, Halaxy automatically issues an invoice sent to the client’s email with an online payment link. Alternatively, direct debit can be set up by entering the client’s card details into the system.

Any outstanding invoices, including late-cancellation fees owing, must be paid before scheduling future appointments.

CANCELLATION POLICY

Cancellations must be communicated via email to your clinician or reception at least 24 hours in advance to avoid a $30 late cancellation fee. Exceptions will only exist for emergencies, unforeseen/extenuating circumstances, or if, by agreement of both parties, the session is rescheduled.

TERMINATION OF THERAPY

If you wish to terminate therapy at the Wellness Hub, please notify your therapist in advance. If possible, please do so during a session so the therapist can have a clear understanding of why you are terminating your therapy and ensure your safety. Otherwise, you may also contact reception via the details below.

HANDOVER

As each provisional psychologist/counsellor concludes their placement at the Wellness Hub, each client may be given the opportunity to continue therapy with another available clinician at the Hub. If interested, the administrator would endeavour to assign a new clinician to the client, based on availability and suitability. Once both parties agree to proceed, the new clinician will be given access to the client’s existing Halaxy profile, including past clinical notes made by the previous clinician(s).

COMMUNICATION

Email communication is preferred. Clinicians/reception staff may also utilise SMS for appointment confirmations and reminders. Please ensure to confirm your appointments via SMS when prompted, e.g. “Reply YES to confirm”.

The Wellness Hub administration team can be contacted via the details below:

Email: wellness.hub@mhfa.org.au
Ph: (03) 8825 3501
Address: G1, 10 Yarra St, South Yarra VIC 3141
AGREEMENT
CLIENT DETAILS
Full Name*

First NameLast Name
Email*
Phone*
Address*

Street Address

Street Address Line 2

City / SuburbState / Territory

Postcode
Signature*

Clear
Date

DayMonthYear
Date
Parental/Guardian Consent for Information Sharing and Communication with School Staff
As the parent/guardian of the child receiving support services on school grounds, I understand that in circumstances where my child may be at immediate risk of harm or presents serious safety concerns, it may be necessary to share relevant personal or health information with designated school wellbeing staff or other appropriate professionals.

I hereby give my informed consent for such disclosure solely for the purpose of safeguarding my child and facilitating timely support. This information will be shared in accordance with applicable privacy and confidentiality laws, and only when deemed necessary for my child’s safety and wellbeing.

Additionally, due to the service being delivered within the school setting, I acknowledge that communication between the clinician and relevant school staff — including the child’s classroom teacher, principal, well-being team and/or vice principal — may be required. The purpose of this communication may include, but is not limited to:
- Coordinating classroom observations
- Discussing observed symptoms and behaviours
- Implementing appropriate classroom strategies and support measures
- I understand that all communication will be conducted professionally and respectfully, with consideration given to my child’s privacy and dignity.
Full Name

First NameLast Name
Email
Phone
Address

Street Address

Street Address Line 2

City / SuburbState / Territory

Postcode
Signature

Clear
Date

DayMonthYear
Date
VIDEO RECORDING CONSENT (OPTIONAL)
By signing, I give my full consent to record my image and speech of my therapy sessions in part or full, held through the Mental Health Foundation Australia (MHFA) Integrated Wellness Hub, as of the date signed in this document.

I understand that the Provisional Psychologists/Counselling students at the MHFA Wellness Hub will analyse and review these recordings to improve the quality of services carried out confidentially and ethically.

I understand that video recordings are not part of my permanent client record and that MHFA Wellness Hub has the sole and exclusive right to view and delete them.

This consent can be revoked without prejudice at my request at any time.
Client's Full Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Guardian Details (if child underage)
Guardian Full Name

First NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

MHFA Wellness Hub Psychology Clinic

Emergency Contact

MHFA Integrated Wellness Hub Client Consent and Agreement Form

AGREEMENT

CLIENT DETAILS

Parental/Guardian Consent for Information Sharing and Communication with School Staff

VIDEO RECORDING CONSENT (OPTIONAL)

Guardian Details (if child underage)