Consent & Registration Form
This consent form details the relevant processes related to your therapy experience at SB Psychology. Please read the following information and complete the form below.
Note that submitting this form constitutes your provision of informed consent.
Collection, Storage & Security of Your Information
Throughout your therapy experience, your psychologist with need to collect and record personal information, as it relates to your current circumstances. This information enables your psychologist to provide relevant and informed therapeutic practice. All client information is stored in accordance with the Victoria Health Records Act (2001).
All information disclosed within sessions is confidential and may not be revealed to anyone without written permission except where disclosure is permitted or required by law. These situations include, but are not limited to: (a) when there is reasonable suspicion of abuse to a child or to a dependent or elder adult; (b) when a client is at risk of harm to others; (c) when a client is at risk of harm to themselves; or (d) when disclosure is required pursuant to a legal proceeding.
If you would like your psychologist to discuss your information with another health professional, parent or other relevant person, you will be need to complete a written consent form.
Note that your psychologist may seek supervision or peer consultation on issues relating to your therapy, as well as discuss themes and ideas arising from therapy in published writing (e.g. blog posts, Instagram), which may involve discussing clients in a non-identifiable way.
Session Fee & Duration
The session fee is $200 and session duration is approximately 50 minutes.
Payment is required at the close of your session and can be made with a debit or credit card.
Mental Health Treatment Plan & Medicare Rebates
If you have been referred under a Mental Health Treatment Plan, Medicare regulations state that your referring GP or psychiatrist must receive regular updates from your psychologist about sessions. Our preferred method of communicating these updates is via online fax.
If you have a referral from a GP or a psychiatrist for a Mental Health Treatment Plan you will be eligible to receive a Medicare rebate of $89.65. After we have processed your payment, assuming you have provided us with all the necessary paperwork, we can process your rebate for you via our online system. Medicare advises that these funds will appear in your bank account within 2-3 business days.
SMS reminders are sent approximately 24-48 hours before appointments. Please do not respond to this text. If you need to cancel or reschedule your appointment, please text 0450 714 262 or email firstname.lastname@example.org.
Cancelling or Rescheduling Appointments
SB Psychology has a 24-hour cancellation and rescheduling policy. This means if you cancel or change your appointment within 24 hours, unless there is an emergency you will be charged the full fee for this session. By giving us more than 24 hours of notice you allow us enough time to offer your appointment to other clients who may be on waiting lists. For all scheduling matters, please contact email@example.com. Please note that Medicare or private health insurance does not issue rebates for unattended appointments.
Limitations of Telehealth Services
Telehealth sessions are any sessions conducted via phone or online video.
The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology used.
A Telehealth consultation may be subject to limitations such as an unstable network connection which may affect the quality of the psychology session. In addition, there may be some situations for which Telehealth is not appropriate or effective. Your psychologist will consider and discuss with you the appropriateness of ongoing Telehealth sessions.
Like face-to-face sessions, it is important that Telehealth sessions are conducted in a private and confidential space (unless otherwise agreed upon), where you are the only person present.
Please be aware that your psychologist does not provide emergency services. If you require immediate assistance, please call 000 or Lifeline on 13 11 14.
Completing This Form
If you understand and agree with what is outlined above, please complete this form prior to your first session. If you have any questions that you would like to ask before completing the form, please call or email, or bring them along to your first session.