Do you identify as Aboriginal, Torres Strait Islander, Aboriginal and Torres Strait Island?
Do you consent to Crystal Clear Psychology Solutions contacting the above mentioned professional for the purpose of information gathering in order to provide assessment and treatment?
As part of providing a professional psychological service to you, Crystal Clear Psychology Solutions will need to collect and record personal information from you that is relevant to your current situation. All personal information gathered by Crystal Clear Psychology Solutions during the provision of the psychological service will remain confidential and secure except where:
1. It is subpoenaed by a court, or
2. Failure to disclose the information would place you or another person at serious and imminent risk; or
3. Your prior approval has been obtained to: a. provide a written report to another professional or agency. e.g. a lawyer; or b. discuss the material with another person, eg. a parent or employer.
4. To provide a letter to your GP for the purpose of outlining your attendance in therapy and an outline of treatment modalities used, as per the requirements of Medicare.
All of the above exceptions to confidentiality are extremely rare, but it's important for you to be aware of these limitations of confidentiality under exceptional circumstances.
Crystal Clear Psychology Solutions offers telehealth psychological services via phone or video.
You have a right to confidentiality with Telehealth under the same laws that protect the confidentiality of your medical information for in-person psychotherapy. Any information disclosed during your therapy, therefore, is generally confidential. There are risks unique and specific to Telehealth, including but not limited to, the possibility that our therapy sessions or other communication by the therapist to others regarding my treatment could be disrupted or distorted by technical failures or could be interrupted or could be accessed by unauthorized persons.
Coviu is a secure (encrypted) video conferencing system, and is virtually impossible for anyone to intercept and decrypt the video transmission between two people. Please see the Coviu website (https://www.coviu.com) for more information on Coviu privacy policies. Crystal Clear Psychology Solutions is not responsible or liable for compromised Coviu communication between you and your psychologist. It is very important you keep your information secure and private, and routinely check your computer system for viruses and trojans.
Recording of counselling sessions
Recording of sessions is a violation of our confidentiality agreement and is strictly prohibited. Management reserves the right to suspend all counselling services to any client who records or retransmits any part of a counselling session.
Crystal Clear Psychology Solutions will utilise NovoPsych to administer specific assessments when utilising telehealth options. NovoPsych is an Australian based psychometrics software company. You will receive a direct email from NovoPsych and be able to complete the assessment online accordingly. Please visit NovoPsych’s website if you require further information - https://novopsych.com.au.
The fee for any other services, for example written reports or an additional psychometric assessment, will incur additional charges and will be advised at the time of request. Crystal Clear Psychology Solutions reserves the right to reschedule appointments at any time, without compensation, if it is deemed necessary due to staff illness or other unforeseen circumstance.
Fees and Financial Consent
For private fee-paying clients, the cost of a one-hour counselling session is $110.00 and payable upon completion of the appointment. NDIS counselling appointments are charged at $180 per session. All fees are payable by the end of the session by Bank Transfer, Eftpos or Credit. An invoice will be supplied at the completion of the session. Rates may be subject to change. Please refer to our fee schedule for more information on applicable fees with Crystal Clear Psychology Solutions.
Missed Appointment Fee
Due to the high demand for appointments, this practice has a Missed Appointment Fee. All clients receive
a text 48 hours prior to their appointment. Please notify us at your earliest convenience once you have
received the text should you wish to reschedule or cancel, please phone to 0476 758 096. It is essential
that you cancel appointments with enough notice to be able to offer the appointment to another client on
the waitlist. Any appointments cancelled within 24 hours of the scheduled appointment will be charged
the full fee amount. Medicare or other parties do not cover the costs of non-attendances or late
cancellations. The cancellation fee must be paid before any future appointments are scheduled, and within
24 hours. Your understanding is appreciated.
I have read and understood the above Consent Form. I agree to these conditions for the psychological service provided by Crystal Clear Psychology Solutions.