Docsity
Log inSign up
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search Store documents

The best documents sold by students who completed their studies

Search through all study resources
Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

University Rankings

Discover the best universities in your country according to Docsity users

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

From our blog

Exams and Study
Go to the blog

Consent Form | Restore Psychology, Study notes of Psychology

University of NorthamptonPsychology

This information informs the assessment and treatment being provided. Your informed consent will be obtained before any treatment.

Typology: Study notes

2021/2022

Uploaded on 09/12/2022

slupdoggy
slupdoggy 🇬🇧

3.4

(5)

215 documents

1 / 2

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
ConsentForm
PsychologicalService
As part of providing a service to you, Restore Psychology needs to collect and record personal
information from you that is relevant to your presenting concerns. This information informs the
assessment and treatment being provided. Your informed consent will be obtained before any treatment
procedureisinitiated,andyoumaywithdrawfromtreatmentatanytimewithoutprejudice.
Confidentiality&PrivacyInformation
Your personal information is gathered as part of your assessment and treatment and is kept securely. In
the interests of your privacy, only your treating Psychologist and authorised personnel of the practice can
accessthisinformation(asnecessary).
All personal information gathered during the provision of the psychological service will remain
confidentialandsecurewiththeexceptionofthefollowing:
1.Itissubpoenaedbyacourt,or
2.Failuretodisclosetheinformationwould(inthereasonableopinionofyourPsychologist),
placeyouoranotherpersonatriskofharm;or
3.Yourpriorapprovalhasbeenobtained(asindicatedbelow)to:
a)Provideawrittenreporttoanotherprofessionaloragency,e.g.aGPoralawyer;or
b)Discussthematerialwithanotherperson,e.g.aparentoremployer
4.Aregulatorybodyrequeststhisinformation,
5.Orthedisclosureisotherwiserequiredbythelaw.
It is important you know that your privacy is protected at all times, and that our Psychologists follow
strictguidelinesforprofessionalconductwhichincludeconfidentiality.
Your personal record will include information gathered during your assessment which allows us to plan
an appropriate course of treatment for you. It will also contain notes about subsequent sessions you
attend.Youmayrequesttoseetheinformationkeptonyourclientrecord.
Should you apply for Life or Permanent Disability Insurance, you may be asked whether you have
previously been treated by a Psychologist. Should you deny, you may later be refused a payout on this
basis. Should you disclose that you are seeing a Psychologist, the insurance company may request to
contact the Psychologist. The policy may be withheld should you refuse to disclose the requested
information.
Fees
Fees are dependent on a number of factors including: the length of consultation (usually 50 minutes), the
Psychologist you are seeing, the service being provided and your form of referral. Fees are payable at the
time of your consultation via EFTPOS, cash, credit card or through third party arrangement. For
convenience(andwhereeligible),yourMedicarerebatewillbeprocessedafteryourconsultation.

pf2

Partial preview of the text

Download Consent Form | Restore Psychology and more Study notes Psychology in PDF only on Docsity!

Consent Form

Psychological Service As part of providing a service to you, Restore Psychology needs to collect and record personal information from you that is relevant to your presenting concerns. This information informs the assessment and treatment being provided. Your informed consent will be obtained before any treatment procedure is initiated, and you may withdraw from treatment at any time without prejudice. Confidentiality & Privacy Information Your personal information is gathered as part of your assessment and treatment and is kept securely. In the interests of your privacy, only your treating Psychologist and authorised personnel of the practice can access this information (as necessary). All personal information gathered during the provision of the psychological service will remain confidential and secure with the exception of the following:

  1. It is subpoenaed by a court, or
  2. Failure to disclose the information would (in the reasonable opinion of your Psychologist), place you or another person at risk of harm; or
  3. Your prior approval has been obtained (as indicated below) to: a) Provide a written report to another professional or agency, e.g. a GP or a lawyer; or b) Discuss the material with another person, e.g. a parent or employer
  4. A regulatory body requests this information,
  5. Or the disclosure is otherwise required by the law. It is important you know that your privacy is protected at all times, and that our Psychologists follow strict guidelines for professional conduct which include confidentiality. Your personal record will include information gathered during your assessment which allows us to plan an appropriate course of treatment for you. It will also contain notes about subsequent sessions you attend. You may request to see the information kept on your client record. Should you apply for Life or Permanent Disability Insurance, you may be asked whether you have previously been treated by a Psychologist. Should you deny, you may later be refused a payout on this basis. Should you disclose that you are seeing a Psychologist, the insurance company may request to contact the Psychologist. The policy may be withheld should you refuse to disclose the requested information.

Fees

Fees are dependent on a number of factors including: the length of consultation (usually 50 minutes), the Psychologist you are seeing, the service being provided and your form of referral. Fees are payable at the time of your consultation via EFTPOS, cash, credit card or through third party arrangement. For convenience (and where eligible), your Medicare rebate will be processed after your consultation.

Consequences of not providing personal information If you do not wish for your personal information to be collected as outlined, your Psychologist may not be in a position to provide the psychological service to you. You may request to be anonymous or to use a pseudonym, unless it is impracticable for your Psychologist, or if Restore Psychology is required or authorised by law to interact with identified individuals. In most cases it will not be possible for you to be anonymous or to use a pseudonym, however if your Psychologist agrees, your consultation fees must be paid at the time of consultation. Access

At any stage you are entitled to access your personal information kept on file, subject to exceptions in the relevant legislation. Your Psychologist may discuss with you different possible forms of access.

If you have a GP Mental Health Care Plan, we are required to report on your progress to your referring GP or other medical specialist over the course of your treatment.

Psychologists are mandated to engage in peer supervision on a continuing basis. Only relevant information will be shared with the peer supervisor for the purpose of meeting this requirement.

Cancellation Policy

If for some reason you need to cancel or reschedule your appointment, Restore Psychology requires a minimum of 24 hours notice. A cancellation fee of $50 will be payable to cover associated expenses which is payable prior to your next session. APS Charter for Clients of Psychologists I have read and understood this information as well as the ‘ Charter for Clients of Psychologists’ which has been made available to me.

Written Consent I, (please print) _______________________________ have read and understood the above Consent Form. I agree to the conditions for the psychological service provided by Restore Psychology.

Client Signature __________________________________________ Date …./…./….

Where Relevant: I, (please print) _______________________________ provide consent for the exchange of verbal and written correspondence about my psychological condition and treatment with ( name of relevant individual or organisation) _____________________________________________________________.

Client Signature __________________________________________ Date …./…./….

If the client is under 18 years of age:

Parent/Guardian’s Name: ____________________________________

Parent/Guardian’s Signature: ________________________________ Date …./…./….