Consent Form + T&Cs for One on One Bookings
Please carefully read the following information. This information pertains to your treatment sessions with Amy Brown Psychologist (Referred to throughout as ‘the practice’; Registered under Amy Louise Brown ABN 96 430 564 984) and the terms and conditions for booking a session. You may wish to discuss any questions with your clinician at the start of your appointment before proceeding or you can email amybrown.psych@gmail.com. Once you have carefully read and agree to all of the above please indicate your consent by proceeding with your booking. You will additionally be asked to sign your agreement to these terms and conditions within the intake forms requiring completion prior to your initial appointment with the practice.
FEES AND CANCELLATION POLICY
If, for some reason you need to cancel or reschedule your appointment (or fail to attend an appointment at the scheduled time) (‘Cancellation’), you must give Amy Brown Psychologist (Referred to throughout as ‘the practice’; Registered under Amy Louise Brown ABN 96 430 564 984) at least 48 hours notice. You will receive an email and/or text message 72 hours prior to your appointment in which you are able to cancel or reschedule your appointment. If less than 48 hours notice is provided for a Cancellation you will be charged the full fee for the cancelled session (‘Cancellation Fee’).
Fees for sessions are clearly outlined on our website and when booking your appointment through Halaxy booking system online, these are automatically charged to your nominated card on file 48 hours prior to the appointment occurring, in the case of cancelled appointments within this period the full fee for service will be retained by the practice. Should you present the practice with a valid medical certificate within 48 hours of the late cancellation you may be entitled to a fee ‘credit’ to be used towards a future session. By continuing you acknowledge and agree that if you do not provide at least 48 hours notice of a Cancellation you will be required to pay the Cancellation Fee, and that this fee will be debited automatically from your nominated account.
By proceeding with booking your appointment you agree for the practice to automatically charge your nominated credit card or debit card the cost of your appointment 48 hrs prior to the scheduled appointment. You agree to ensure you have sufficient funds available in your account at the time of your appointment. Should payment be unsuccessful your appointment will be deemed as cancelled and a reschedule will be required.
Should you request a psychological report or summary of intervention, there will be additional costs charged for these documents, calculated at a pro-rata session fee cost in 15 minute increments.
If your clinician is unable to attend your session for some reason, the practice will contact you to reschedule at the earliest convenience.
All fees are subject to change at the practice’s discretion.
SOCIAL MEDIA POLICY
Amy Brown Psychologist (Referred to throughout as ‘the practice’; Registered under Amy Louise Brown ABN 96 430 564 984) has various social media accounts (including but not limited to Facebook, Instagram and LinkedIn, which allows us to share practice information, news and updates with other social media users. This document outlines the practice's policy relating to our usage of these social media accounts.
Please read it to understand how we conduct ourselves as mental health professionals on social media platforms and how you can expect us to respond to various interactions that may occur between clients and clinicians over the Internet. If you have any questions about anything within this document, we encourage you to bring them up with your clinician. As new technology develops and the Internet changes, there may be times when we need to update this policy. If we do so, we will notify you.
Social Media Activity
If you choose to engage with any of the practice's public social media posts, such as commenting about your own therapeutic experience with the practice, feedback of your clinician or any general reference to being a former or current client with the practice, please know your confidentiality as a client of the practice may be jeopardised.
Friend requests on Social Media
In order to protect your privacy and maintain the boundaries of the therapeutic relationship, the practice requests that former and current clients do not send friend requests to our clinicians personal social media accounts. These requests will not be accepted and will not be responded to. If you are wanting to follow the practice on any social media platform please note you are welcome to do so, however we will not follow you back, as this can jeopardise the therapeutic relationship and breach confidentiality.
Email and communication
Where possible, the practice only uses email to discuss administrative matters like booking appointments or sending links to online resources. Please be aware that any clinical correspondence via email, may be retained in the logs of your and the practice's Internet service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available and searchable by system administrators of Internet Service Providers. You should also know any emails the practice receives from clients and any responses that your clinician sends to you will form part of your clinical records.
Business Review Sites
You may find the practice listed on automatically generated business review sites. Some of these sites include user ratings and reviews. Please be aware these are NOT listings controlled by the practice and we never solicit client reviews or testimonials, as psychologists publishing reviews and testimonials is against our code of ethics. Please be aware that leaving a review may jeopardise your confidentiality as a client of the practice.
Conclusion
Thank you for taking the time to read our Social Media policy. If you have questions or concerns about anything within this policy or regarding our potential interactions on the Internet, do bring them to the attention of your clinician, so that they can be discussed.
PRIVACY + INFORMED CONSENT POLICY
PRIVACY & CONFIDENTIALITY POLICY FOR PSYCHOLOGICAL SERVICES
As part of providing a psychological service to you, Amy Brown Psychologist’s (Referred to as ‘the practice’ throughout, registered under Amy Louise Brown ABN 96 430 564 984) clinicians will need to collect and record your personal information that is relevant to providing psychology services you (or we are required by law to collect). The types of personal information we may collect may include your name, address and date of birth, your contact details, your educational and occupational history and certain types of sensitive personal information including (but not limited to) any current and past medical information, your family medical history, sexual orientation and philosophical beliefs to the extent that they may inform current services, your educational and occupational history. In providing medico-legal services we may also collect your legal or offending history. We may also collect responses and results from psychological tests and questionnaires and information pertaining to your session notes including treatment plans and your response to treatment.
This information will be a necessary part of the psychological assessment and treatment plan and when you engage a clinician at the practice for psychological services you consent to the practice collecting such information. You do not have to give all your personal information, however a failure to do so may affect the psychological intervention outcomes. Psychological services are most effective when the information provided is accurate and comprehensive.
If debts are unpaid, your personal information will need to be provided to third-party debt collector agencies.
By proceeding with booking you confirm you understand that you will be responsible for all costs incurred on the collection of outstanding debts.
CONFIDENTIALITY
All personal information gathered by the clinician during the provision of the psychological service will remain confidential and secure except where:
it is subpoenaed by a court;
failure to disclose the information would place you or another person at serious and imminent risk
your prior approval has been obtained to:
provide a written report to another professional or agency (for example a GP or a lawyer); or
discuss the material with another person (for example a parent or employer).
If disclosure is otherwise required or authorised by law. For example, when the psychological service is at the request of a third party (such as an employer, company, or manager), general data may be given to the third party however your personal information will not be disclosed or identifiable.
Your practice clinician will discuss your confidentiality and the above mentioned limits to confidentiality in your initial session.
TELEHEALTH INFORMED CONSENT
Please note a telehealth video session will not be the same and may not be as complete as a face-to face service. While the efficacy of in-person and telehealth therapy has been found to be similar in most instances, some disadvantages to telehealth psychology sessions might include the dependence on a reliable internet connection for the facilitation of the telehealth session, increased difficulty to perceive non-verbal cues in a telehealth session and limits to care (particularly when risk is present) during a telehealth session. However just like a face-to-face appointment, your telehealth video session will be private and confidential. You will be required to be in a private room and your clinician will also be in a private room. There could be some technical problems that affect the video session which will be discussed in your initial consultation. While Amy Brown Psychologist (Referred to as 'the practice' Registered under Amy Louise Brown ABN 96 430 564 984) uses Halaxy and Zoom software which meets recommended standards to protect the privacy and security of the video sessions, we cannot guarantee complete protection against hacking, data, or confidentiality breaches by third parties.
As you may be in varied locations for each video session, the practice's clinicians will require you to provide your location at the commencement of the session if you are not located at your usual home address which you have provided within your intake forms.
DETAILS OF CONTACTS
Clinicians need to be able to contact support people in your locality should any risk arise. Please provide the names and contact details of at least 2 people known to you who would be able to assist you if needed in a crisis period, before we commence the treatment.
PURPOSE OF COLLECTING & HOLDING INFORMATION
Your personal information is gathered as part of the assessment, diagnosis, and treatment of your condition, and is seen by your clinician or other clinicians within the practice only in the case of a handover. If you have consented for a handover to another clinician at the practice however do not wish for them to have access your information please advise your clinician. Please note this may impact the psychological assessment and treatment plan. Your general information (such as your name, address and date of birth, third-party funding, invoices) may be accessed by administrative staff for the purpose of completing administrative tasks such as updating your address, confirming your appointment or sending and managing invoices.
Your personal information is retained to record what happens during sessions and enable the clinician to provide a relevant and informed psychological service.
ACCESS TO CLIENT INFORMATION
At any stage you as a client are entitled to access to the information about you kept on file unless the relevant legislation provides otherwise.
By proceeding with booking you acknowledge and agree that your provision of information and engagement in services with the practice is completely voluntary, and you have the right to withdraw such consent at any time.
If we need to share information about you with other stakeholders (such as your GP or psychiatrist) for the purpose of treatment planning, where there is no risk present, we will discuss this with you first to outline what will be discussed. You do not have to agree to having this information shared if you do not wish to do so, but please be aware that not sharing such information with other stakeholders can negatively impact your treatment. If you are accessing the service using a valid mental health treatment plan, wish to receive Medicare rebates via this and have therefore been referred by a GP, you will be required to consent to communication regarding your treatment occurring with your GP as this is a requirement of Medicare.
Health professionals are permitted to take notes during consultations, and you agree that your general health and medical information may be used in communication with other stakeholders (such as your GP) or in case conferences, provided that your confidentiality is maintained.
MEDICARE
If you choose to use the Mental Health Care Plan, you give consent to the practice storing your Medicare card details in our practice management software system Halaxy. You accept that our practice management software provider may collect your Medicare card details for the purpose of processing rebates.
PRIVACY OF ONLINE COMMUNICATION
The privacy of any form of communication via the Internet or a mobile device is potentially vulnerable and limited by the security of the technology.
Please be aware that email communication is not secure and should contain minimal personal information. The transmission and exchange of information over the Internet, email or mobile device is carried out at your own risk. The practice cannot guarantee the security of any information that you transmit to us or receive from us.
The practice generally uses email for administrative purposes such as setting up appointments.
Invoices and receipts will be emailed as a PDF document attached to an email automatically by the practice management software Halaxy.
Your clinician may provide you with suggestions to help you protect your own online privacy for your sessions.
Please be aware that you are responsible for any costs incurred in relation to the provision of your own software, hardware and data usage associated with any telehealth service or video session.
USE OF THERAPY SESSION MATERIAL
The practice will not make recordings of sessions or use material from sessions (such as session notes) for purposes other than delivering a service to the individual client. De-identified confidential information may be shared from time to time in the process of seeking expert supervision, this is performed in order to provide the best support to the client, and will be done in a way that protects the client’s identity.
The practice will ask you to respect the privacy of your clinician by agreeing not to make recordings of our sessions and not using materials from sessions for purposes other than your personal therapy. If you wish to record sessions or use session material for other purposes, you must seek your clinician’s written consent to do so.
STORAGE OF RECORDS
Amy Brown Psychologist is a paper-free practice. Electronic records are kept by the practice according to relevant data collection and privacy law in Australia and stored upon the compliant online practice management system Halaxy, with the exception of email communication within password protected Gmail. You understand that the practice cannot guarantee total protection against confidentiality and/or data breaches by third parties.
PAYMENT AUTHORISATION FORM:
By proceeding with booking you authorise Amy Brown Psychologist (Referred to throughout as ‘the practice’, Registered under Amy Louise Brown ABN 96 430 564 984) to process a payment on your nominated credit card:
for the nominated service type;
for any cancellations within 48 hours of the allocated appointment time;
for any failure to attend an appointment at the allocated appointment time; and
for any ad hoc services, i.e. report writing requested by you.
Your credit card will be charged 48 hours prior to your scheduled appointment. Appointments for which payment has not occurred at least 48 hours in advance will be deemed as cancelled and offered to the waitlist by administrative staff.
Your Authority
To protect the security of your details, we store your card details on our online booking system Halaxy. The authorisation of your card will remain in effect until you advise us in writing to cancel it. You may revoke permission at any time by contacting us at amybrown.psych@gmail.com.
By proceeding with booking:
I understand my credit card will be charged 48 hrs prior to my session for the nominated service type as per the aforementioned policy.
I understand my full session fee payment will be retained by the practice if I cancel / reschedule my appointment within 48 hours of the allocated appointment time or fail to attend my appointment at the allocated appointment time as per the practice's cancellation policy.
I understand my credit card will be charged for any ad-hoc services I request, these will be calculated at a pro-rata session fee rate in 15 minute increments and I will be advised of the anticipated cost upon making the request prior to the charge (i.e. report writing).
I authorise the practice to store my credit card details.
I authorise the practice to charge my credit card.
This information pertains to your treatment sessions with Amy Brown Psychologist (Referred to throughout as ‘the practice’; Registered under Amy Louise Brown ABN 96 430 564 984) and the terms and conditions for booking a session. You may wish to discuss any questions with your clinician at the start of your appointment before proceeding or you can email amybrown.psych@gmail.com. Once you have carefully read and agree to all of the above please indicate your consent by proceeding with your booking. You will additionally be asked to sign your agreement to these terms and conditions within the intake forms requiring completion prior to your initial appointment with the practice.