If you have trouble reading or understanding the information in this form please speak with your psychologist and the form will be completed in session.

Recording of personal information

As part of the psychological services provided to you, personal information will be collected and recorded that is relevant to your situation, such as your name, contact details, medical history and other relevant information as part of the provision of psychological services.

Privacy and confidentiality

Your privacy is important and your personal information is handled in accordance with the Privacy Act 1988 (Cth) and professional obligations set by the Psychology Board of Australia.

Your personal information is gathered as part of your assessment and treatment. All of this is kept securely and, in the interests of privacy, used only by your psychologist and other authorised staff (as necessary). Your privacy and the information you provide is protected at all times. Your psychologist adheres to the ethics and code of conduct requirements of the Psychology Board of Australia and its regulating body, the Australian Health Practitioner Regulation Agency (AHPRA). Your personal information is retained in order to document what happens during your sessions, and enables your psychologist to provide a relevant and informed psychological service to you. This information is required by law to be kept for no less than 7 years. You are entitled to access your personal information kept on file at any time by making a request of your psychologist.

Communication by email, text message or telehealth involves some privacy risks. While reasonable steps are taken to protect your information, absolute confidentiality cannot be guaranteed. These forms of communication should not be used for urgent or crisis matters, or highly sensitive information.

Your information will be kept strictly confidential except when:

1. It is subpoenaed by a court

2. You give permission to release your information to a third party

3. Disclosure is otherwise required by law

4. You disclose a serious risk to life, health or safety to yourself or others

5. Your psychologist is consulting with other psychological supervisors and/or peers to further improve the support and treatment provided to you (whom in turn will maintain strict confidentiality of your information).

Continuity of care

Psychologists have a responsibility for ensuring continuity of psychological care for clients who choose to end the therapeutic relationship and wish to continue psychological treatment, or when the psychologist feels the client’s needs would be better met by another professional, as well as in instances where the psychologist is unable to continue treatment due to circumstances, injury, illness or death. When relevant, your psychologist will attempt to refer you to another treating psychologist and seek your consent to provide your clinical notes. In the event of death or serious illness, the estate or Power of Attorney of your psychologist will have access to your records for the purposes of notification as well as providing information to your next treating psychologist. This information will be stored securely and kept confidential.

Payment terms

Payment of session fees is due at the time of the session (for in person sessions) or within 7 days of your invoice (for digital sessions). Please refer to the fee page for current service rates. Payment types accepted include debit or credit card, digital wallet cards, tap and go, Beem, PayID and cash. Card payments incur a 1.6% surcharge. Afterpay is available but incurs a higher surcharge fee. You may be eligible for Medicare or health fund rebates. For these sessions you are required to pay the full session fee upfront and your rebate will be processed by Body Sense Psychology or you will be provided with an invoice for claiming the rebate yourself.

Cancellation policy

Please give at least 24 hours notice if you are unable to attend your appointment, otherwise you may be charged a late cancellation / non-attendance fee up to the full session fee. This must be paid in full prior to your next session. Late cancellations for situations beyond your control (e.g. illness, car failure, family emergency) are acceptable and will not incur a fee.

Boundaries of service

The code of conduct for psychologists requires professional boundaries with current and prior clients to be maintained at all times. Engagement in social events and relationships is not permitted. Occasionally clients may wish to offer a gift. To protect the therapeutic relationship and avoid misunderstandings or pressure, gifts are generally not expected and are usually declined. Small, low-value tokens (such as a card) may be accepted at the psychologist’s discretion where this does not create a sense of obligation, influence the therapeutic relationship, or cause discomfort. Any gift that could affect professional boundaries will not be accepted. Physical contact with you is not permitted except if there is a therapeutic benefit and consent is given. You may request physical contact if there is a therapeutic need (such as a hug or minor touching when distressed), but only where professional boundaries are maintained.

Informed consent

By completing this form you are giving informed consent and acknowledge that you have read and understood all the terms and conditions of service and agree to the provision of psychological services by Body Sense Psychology. Consent is an ongoing process and will be revisited if there are changes to the nature, risks or focus of therapy. You have the right to withdraw consent for treatment at any stage. This includes ending the therapeutic relationship as well as withdrawing consent for psychological treatments or approaches. Your psychologist will discuss treatment plans and approaches with you during the therapeutic process and gain consent and agreement for this plan. Should you have concerns or are uncomfortable with a proposed treatment approach you have the right to reject consent for this, whilst still continuing with broader treatment. Any concerns should be communicated to your psychologist for resolution. You may do this in session, via email, text message or phone call.