PARENT/GUARDIAN CONSENT FORM
All psychologists at Bluff Road Psychology (BRP) are registered Psychologists with the Australian Health Practitioner Regulation Agency’s Psychology Board of Australia. As part of providing a psychological service which may include assessment and/or counselling to your child, your psychologist needs to collect and record personal information about you and your child 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 your child. This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted.
Sometimes during the course of assessment and therapy, your psychologist may deem that your child’s needs have changed and another psychologist is better suited to your child’s situation. Your psychologist will discuss this with you and recommend an appropriate referral for your child’s continued care.
(We are not a forensic service and we do not provide documentation for court)
Purpose of collecting and holding information
Your personal information is gathered as part of your assessment and treatment, is kept securely and, in the interests of your privacy, 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. If you do not wish for your personal information to be collected in a way anticipated by this letter, your psychologist at BRP may not be in a position to provide the psychological service to you. All records of therapy will be kept until your child reaches 25 years of age, or 7 years after their last therapy session; whichever is longer.
Access to your child’s information
It is important that your child feels safe during their sessions with their psychologist. This often comes with the need to limit disclosure to the parent/guardian regarding the content which your child may discuss with their psychologist. Limits of confidentiality will be discussed with your child so that they are aware that the psychologist has a legal obligation to keep them safe. This may mean disclosing certain information to their parent/guardian. Agreements on the level of disclosure to the parent/guardian will be developed on a case-by-case basis. You are entitled to access the information in your child’s file through Freedom of Information, unless the relevant legislation indicates otherwise. In some cases, certain information may need to be excluded from access. You can discuss appropriate forms of access with your psychologist directly.
- All information is stored securely in accordance with relevant legislation and ethical standards
- Information provided by you or obtained from other parties (e.g. GP) is regarded as confidential and cannot be released without your written permission.
- The exceptions to these provisions arise in the following circumstances: o There is a risk of serious harm to yourself or others o Your file is subpoenaed by a court of law, or disclosure is otherwise required or authorised by law o There is evidence of child abuse or neglect, including sexual abuse of a child under 16 years o If you, or someone legally authorised to act on your behalf, gives consent to disclose information.
- If referred by a medical practitioner under the Better Access Mental Health Scheme your treating psychologist is required to provide periodic summaries to the referring GP, Psychiatrist, or Paediatrician. Should a decision to disclose information be made for any of the above reasons, all reasonable attempts will be made to discuss this with you prior to disclosure.
Where appropriate, telehealth services can be provided via telephone and video conferencing. Unless otherwise requested by you, the consult will be conducted via videoconferencing. At the time of your appointment, you will be sent a link to your email to access the video consultation. To access telehealth consultations, you will need access to a quiet, private space; and the appropriate device, i.e. smartphone, laptop, iPad, computer, with a camera, microphone and speakers; and a reliable broadband internet connection.
The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology used. To support the security of your personal information, this practice uses end-to-end encryption telehealth software with strict privacy and security standards.
Please do not record video or audio sessions without your psychologist’s consent. Making recordings can quickly and easily compromise your privacy, and should be done so with great care. Your psychologist may request your consent to record video or audio for them to use as part of their supervision.
- Payments are to be made in full on the day of the consultation. The Bluff Road Psychology reception team will retrieve and securely store your credit card details at the time of your booking and process the payment of your session on the same day.
- The standard consultation fees are: o Individual telehealth session – $250 (Medicare rebate* of $89.65 – $131.65) o Individual face-to-face session (weekdays) – $250.00 (Medicare rebate* of $89.65 – $131.65)
- Individual face-to-face session (after 6pm and weekends) – $265.00 (Medicare rebate* of $89.65 – $131.65)
- *Medicare rebates are only available to clients with a current ‘GP Mental Health Care Plan’
- You may be able to claim a rebate through your private health insurance provider. Please advise reception if you intend to do this, and you will be provided with the relevant paperwork to forward to your provider
- Clients eligible to have their costs subsidised by NDIS, TAC or Workcover/Worksafe, are required to settle their account on the day of consultation. The client is solely responsible for claiming any reimbursements from various agencies.
- As per Bluff Road Psychology policy, a $15.00 accounting fee will be charged if your account is not paid in full on the day of the consultation, and accounts referred to a debt collection agency or solicitor will incur a debt collection fee.
Appointments are 50 minutes duration; your understanding and patience is kindly requested on rare occasions where your appointment commencement time may be slightly delayed. 30-minute appointments can be requested where clinically appropriate after an initial assessment with your psychologist has been conducted.
Email and SMS reminders of appointments are sent to clients 5 days prior to appointments. Reminders are a courtesy service and should not be solely relied upon. Normally appointments are booked well in advance to reserve particular days and times, therefore it is the responsibility of parents/guardians to be aware of their child’s appointments and to attend or provide notice of cancellations.
By signing this form, you accept the terms and conditions above and agree to the conditions for the psychological services provided by your psychologist at Bluff Road Psychology, for my nominated child/adolescent. For telehealth services, by signing this form, you agree that in circumstances where the psychologist is concerned about your child/adolescent’s welfare and is unable to contact you, permission is provided for the psychologist to contact the emergency contact listed.
Agreement to accept responsibility for Medicare rebates
The Federal Government has introduced rebates for certain Psychology services when appropriately referred by a General Medical Practitioner (GP), Paediatrician or Psychiatrist. Relevant rebates will only be paid for Psychology services by Medicare where the referring medical practitioner has completed certain referral requirements, for example, having developed a “Mental Health Care Plan.” While we endeavour to ensure that we complete the procedures that are necessary for you to claim a rebate, it must be understood that we cannot be responsible for your eligibility for any claim for a Medicare rebate. This rests with the referring medical practitioner. If the referring medical practitioner has not completed any referral or review procedures correctly to enable your rebate to be accepted, you will remain liable for the full payment of any fees, and you hold the responsibility for resolving any errors with the referring medical practitioner or Medicare Australia.
Additionally, we cannot be responsible for Medicare processing errors which may result in the delay of your rebate.