INFORMED CONSENT

Collection of Personal Information

Personal information relevant to your current situation is collected and recorded as part of providing psychological assessment and treatment.

Record Keeping

The psychologist may take notes during the session and will make a record of your assessment and treatment following the session. Accurate record-keeping by psychologists is an ethical and legal requirement. Records will be securely stored in a password-protected location. Upon request, you may access the material recorded in your file, subject to the exceptions outlined in National Privacy Principle 6.

Limits to Confidentiality

All personal information collected or recorded by the psychologist will remain confidential, except in the following circumstances:

1. Failure to disclose the information would place you or another person at risk of harm,

2. The information is subpoenaed by a court,

3. Your prior approval has been obtained to provide a written report to a professional or agency, e.g. a GP or a lawyer, or, to discuss the material with another person, e.g. a family member.

Please note that as part of the Medicare Better Access Scheme, psychologists are required to write progress reports to your GP. This is to ensure your continued eligibility for Medicare rebate and your GP's involvement in your treatment.

Cancellation Policy/Late Cancellation Fee

A 48-hour notice is required for all cancellations. Cancellations made without 48 hours notice will incur a late cancellation fee of $50. Cancellations made without 24 hours notice will incur a late cancellation fee equal to the full cost of the session.

Limitations of Service

This service is not intended for emergencies, and the psychologist may not always be available at short notice or outside regular consultation hours. If you require emergency assistance, please consult your psychologist for details of alternative services.

Requests for support letters or psychological reports

Fees for psychological reports vary based on their nature and scope. Upon request, you will be provided with a quote. Please note that a minimum of 7-14 days notice is required to prepare support letters, and additional time may be needed for court reports..

Consent

Please print your name below and check the checkbox to indicate your agreement to these conditions for the psychological service provided by the psychologist at Shikha Gray Psychology.

Please feel free to print a PDF copy of this form for your records.