Informed Consent Form

Consent for Service

Your consent is required for us to provide a psychological service. Your psychologist will explain the benefits and any potential risks of accessing psychological services. Please ensure that you fully understand the information provided and ask for further information if you are unclear about anything in this consent form.

Personal Information

As part of providing a psychological service  to you, Australian Clinical Psychologists  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 as part of providing psychological services to you.  This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted though you do not have to provide all of your personal information. 

Purpose of collecting and holding information

Your personal information is gathered as part of your assessment and treatment, and is kept securely.  It is used only by your psychologist and the authorised personnel of the practice (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.  In specific circumstances deidentified data such as scores on questionnaires might be used for research purposes. This data will not include anything that can identify you such as name or date of birth. 

Information Storage

Your information is stored securely.  It is only accessed by your psychologist, and if necessary, by authorised staff and personnel engaged by this practice in accordance with the practice’s policies and procedures.  A more detailed description is provided in the practice’s “Privacy policy for management of personal information”, which can be accessed here. The Privacy Policy contains information about how to access and seek correction of your personal information, and how to lodge a complaint about our management of your personal information.

Consequence of not providing personal information

If you do not wish for your personal information to be collected in a way anticipated by this letter or the Privacy Policy, Australian Clinical Psychologists may not be in a position to provide the psychological service to you.

Access to your information

At any stage you are entitled to access your personal information kept on file, subject to exceptions in the relevant legislation. The psychologist may discuss with you different possible forms of access.  If you would like to access your information, please discuss it with us or you can request it in writing.

Confidentiality of information

All personal information gathered by the psychologist during the provision of the psychological service will remain confidential though there are exceptions.

Your consent will be requested

1. to provide verbal or written reports to another professional or agency such as a GP, insurer or lawyer; or
2. to discuss the material with another relevant person, such as a parent, employer or other health provider; or
3. when making associated referrals for yourself or others such as family members as agreed with the psychologist; or
4. to disclose the information in another way requested by you.

Exceptions to Confidentiality

There are situations where your personal information may be released without obtaining your consent, including when:

1. it is subpoenaed by a court; or
2. the psychologist believes you or another person is at risk of serious harm, or
3. it is required because the psychologist must make a mandatory report, or
4. disclosure is otherwise required or authorised by law.
5. For research purposes, though no identifiable information will be released such as name or date of birth (data will be anonymous).

Use of artificial intelligence (AI)

A note-taking tool, Heidi, that utilises AI will be used with your consent.  Heidi is compliant with the Australian Privacy Principles and the Privacy Act.  All data is encrypted and stored within Australia.  Audio recordings are not retained.  Notes generated by Heidi will be reviewed and amended by your clinician and stored as part of the usual client file.  Data will only be used to provide you with a service.

Fees 

The cost of a standard consultation (usually around 50 minutes) is $318 in line with the Australian Psychological Society recommended fee, which is payable at the end of the session by electronic card (credit, savings or cheque) unless prior agreement has been provided by Australian Clinical Psychologists that treatment costs will be covered by a third party payer.

Cancellation Policy

If, for some reason you need to cancel or postpone your appointment, please give the psychologist at least 48 hours notice, otherwise you will be charged a cancellation fee of $120.

How to Make a Complaint

If you have any concerns about your contact with our clinic, please discuss these with your psychologist. If you would like to make a complaint, please contact us by writing to enquiries@austclinpsychs.com.au

APS Charter for Clients of Psychologists

You can access a copy of the APS Charter for Clients of Psychologists by clicking here.

Period of Consent

This consent will remain valid as long as the service continues to be provided.  It will lapse if there is a minimum of 12 months without contact following the last appointment.  You are also able to withdraw consent at any time, though consent cannot be withdrawn retrospectively (for services that have already been provided).