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Terms, Conditions, Confidentiality and Cancellation Policy
May 2023
Down South Psychology Pty Ltd
ABN: 31 650 445 748
Medicare Provider Number 4677362H
CONSENT FORM FOR PSYCHOLOGICAL SERVICES
As part of providing a psychological service Down South Psychology Pty Ltd needs to collect and record personal information from you, such as your name, contact information, medical history and other relevant information. The collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted.
Purpose of collecting and holding information
Your personal information is gathered as part of your assessment and treatment, is kept securely (lock and key, encrypted storage, or both) and in the interests of your privacy, will be used only by your psychologist. 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.
Disclosure of personal information
All personal information gathered by the psychologist during the provision of the psychological service will remain confidential except when:
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It is subpoenaed by a court, or disclosure is otherwise required or authorised by law; or
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Failure to disclose the information would in the reasonable belief of the Practice, place you or another person at serious risk to life, health or safety; or
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Your prior written approval has been obtained to
· provide a written report to another professional or agency. e.g., a GP or a lawyer; or
· discuss the material with another person, e.g., a parent, employer, health provider or third party funder (such as Workcover); or
· disclose the information in another way; or
· disclose to another professional or agency (e.g., your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected.
Your personal information will not be used, sold, rented or disclosed for any other purpose.
Fees
The cost of a 50 minute consultation is $235, which is payable at the end of the session by EFTPOS, credit card or direct deposit. For those requesting Telehealth counselling (via telephone, Skype or Zoom), payment is required at the beginning of the consultation.
Medicare will rebate $89.65 for those registered with Medicare and who have a Mental Health Treatment Plan and referral from their GP. Clients who wish to pay privately may do so. Bulk billing is not offered by this service.
Out of Hours Contact
If you have any questions contact us via the Contact Us tab, email, mobile and text is welcome during the day. The mobile number provided to you (0432 551 581) however is not a crisis telephone service and will be on silent throughout the day and night.
The email address associated with the practice (downsouthpsychology@gmail.com) is also not a crisis email. Emails sent to this address will not necessarily be responded to on the same day.
If you are in crisis it is important that you call an emergency service, such as Lifeline: 13 11 14.
Requests for Letters or Reports
Requests for letters or reports for the workplace, court, university, or other purposes are charged according to the time taken to write them. The APS Schedule of Fees is used as a guide for requests for letters and reports.
Cancellation and Rescheduling Appointments
If for some reason you need to cancel or postpone your appointment, please try to give the at least three full business day’s notice. You can do this via the Contact Us tab on our website, by emailing downsouthpsychology@gmail.com, by sending a text, or by leaving a voicemail message on 0432 551 581.
Failure to cancel or reschedule with less than three full business day’s notice will incur a fee of $120. Any appointments cancelled less than 24 hours in advance will be charged the full fee. If you have a medical certificate, then this fee will be waived. Please understand that other clients might be waiting for an appointment so they can access counselling support sooner.
Late Attendance
If you have not arrived for your appointment and 10 minutes has passed, Down South Psychology Pty Ltd will attempt to call your mobile number to see if you are still attending your appointment. Please understand that it will not be possible to extend your appointment beyond its allocated slot.
Duration of Session
Each appointment slot will be 60 minutes (the clinical session lasts for a maximum of 50 minutes), however this includes scheduling your next appointment (if needed) and payment.
Administrative tasks (phone calls and letters) need to be completed in between clients. Persons who arrive before the scheduled time may be asked to wait.
APS Charter for Clients of Psychologists
The APS Charter explains your rights as a client of a psychologist. In signing (or ticking the below box) to this agreement you are also acknowledging that you have read and understood both your client rights as well as limitations to confidentiality.
The Charter for Clients of APS Psychologists is at the following address:
Signing below means that you agree to the above conditions for the psychological service provided by Down South Psychology Pty Ltd.
Please note, if you are unclear about any of the information provided in these terms, or if you have any questions, please contact Down South Psychology Pty Ltd prior to your appointment. Contact can be made via the Contact Us tab, via email to downsouthpsychology@gmail.com or via mobile on 0432 551 581.
If you agree with these terms and conditions please sign and date below:
Signature: _____________________
Date: _________________________
A copy of these terms is available at downsouthpsychology.com.