Consent form

As part of providing a psychological service to you, Clear View Psychology needs to collect and record personal information from you that is relevant to your situation, such as your name, contact information, medical history and other relevant information. This information informs the assessment and treatment being provided. Your informed consent will be obtained before any treatment is initiated and you may withdraw from treatment at any time without prejudice.

 

Confidentiality and Privacy

Your personal information is gathered as part of your assessment and treatment and is kept securely. In the interests of your privacy, only your psychologist and the authorised personnel of the practice can access this information (as necessary). Your personal information is retained in order to document what happens during sessions, and enables the psychologist to provide a relevant and informed psychological service to you.

 

Limits to confidentiality

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

  1. It is subpoenaed by a court; or
  2. Failure to disclose the information would, in the reasonable belief of your Psychologist, place you or another person at risk of harm; or
  3. Your prior approval has been obtained to:
    • Provide a written report to another professional or agency (e.g. GP, school, or lawyer); or
    • Discuss the material with another person (e.g. a parent or employer);
  4. Disclosure is otherwise required or authorised by law.

It is important you know that your privacy is protected at all times, and that our Psychologists follow strict guidelines for professional conduct which include confidentiality. Your personal record will include information gathered during your assessment which allows us to plan an appropriate course of treatment for you. It will also contain notes about subsequent sessions you attend. You may request to see the information kept on your client record. If you do not wish for your personal information to be collected as outlined, your psychologist may not be in a position to provide the psychological service to you.

 

Access

At any stage you are entitled to access your personal information kept on file, subject to exceptions in the relevant legislation. Your Psychologist may discuss with you different possible forms of access. If you have a GP Mental Health Care Plan, we are required to report on your progress to your referring GP or other medical specialist over the course of your treatment. Psychologists are mandated to engage in peer supervision on a continuing basis. Only relevant information will be shared with the peer supervisor for the purpose of meeting this requirement.

 

Cancellation Policy

To ensure that Clear View Psychology provides the highest quality of care to our clients, please give at least 48 hours notice if you are unable to attend your scheduled appointment. If this notice period is not provided, a cancellation fee of 50% of the appointment will be payable to cover associated expenses which is payable prior to your next session. If 24 hours or less notice is provided of your cancellation, a cancellation fee of 100% of the appointment will be payable to cover the associated expenses. If there have been two instances of non- attendance or repeat cancellations, Clear View Psychology reserves the right to not schedule any further appointments and refer you back to your GP. Please note that Clear View Psychology will aim to provide you with text message reminders three days prior to every appointment, however these text messages are a courtesy only, and not to be relied upon.

Your cancellation notice would be much appreciated, as this can enable us to provide services to other clients who
may be in need of an urgent appointment.

PLEASE NOTE: You will be asked to sign a consent form once you have booked your consultation. 

If there is anything written on this form that you do not understand, please discuss it with your Psychologist before you sign.