Consent Form

Psychological service

As part of providing a psychological service to you, Mindfully Curious needs to collect and record personal information from you 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 you. All personal information is kept in Halaxy.

This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted.

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. A more detailed description is provided in the practice’s “Privacy policy for management of personal information”, which can be obtained by asking your Psychologist (contact details can be provided upon request). The Privacy Policy contains information about how to access and seek correction of your personal information, and how to lodge a complaint about our management of your personal information. If you would like a copy of this, please ask your Psychologist.

If you do not wish for your personal information to be collected in a way anticipated by this form or the Privacy Policy, Mindfully Curious 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 Mindfully Curious to deal with you or if Mindfully Curious is required or authorised by law to deal with identified individuals. In most cases it will not be possible for you to be anonymous or to use a pseudonym, however if Mindfully Curious agrees to you being anonymous or using a pseudonym, you must pay consultation fees at the time of the appointment.

Access to client information

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

Disclosure of personal information

All personal information gathered by the psychologist during the provision of the psychological service will remain confidential and will only be viewed by your Psychologist and Mindfully Curious admin staff. Please be aware that Mindfully Curious admin staff do not have access to your clinical notes, only your general file information.

All personal information will be kept confidential except when:

  • it is subpoenaed by a court; or

  • failure to disclose the information would in the reasonable belief of you or another person at serious risk to life, health or safety (including if there is an immediate risk to you or another (including minors);

or;

  • your prior approval has been obtained to

  • provide a written report to another professional or agency. e.g., a GP or a lawyer; or

  • discuss the material with another person, eg. a parent, employer or health provider; or

  • disclose the information in another way; or

  • you would reasonably expect your personal information to be disclosed to another professional or agency (e.g. your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected; or

  • disclosure is otherwise required or authorised by law.

Your personal information is not disclosed to overseas recipients, unless you consent or such disclosure is otherwise required by law. Your personal information will not be used, sold, rented or disclosed for any other purpose.

Provision of a telehealth service

Where appropriate the service may be provided by telephone or videoconferencing. You are responsible for the costs associated with setting up the technology needed so you can access telehealth services. Mindfully Curious will be responsible for the cost of the call to you and the cost associated with the platform used to conduct telehealth services.

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 the Zoom platform which is compliant with the Australian standards for online security and encryption.

Limitations of telehealth

A telehealth consultation may be subject to limitations such as an unstable network connection which may affect the quality of the psychology session. In addition, there may be some services for which telehealth is not appropriate or effective. Your psychologist will consider and discuss with you the appropriateness of ongoing telehealth sessions.

Invitations to alternate modes of therapy, spaces & resources

Mindfully Curious has a range of supports including group courses, webinars, masterclasses, online e-health and digital products which can be purchased at an additional fee outside of individual psychological therapy sessions. Given the holistic nature of Mindfully Curious, you are invited to these alternate options as a complement to your individual therapy sessions in order to enhance the therapy you are undertaking. They include (and are not limited to);

  • Nourishing the Nervous System: A space for Uncertain Times workshop (90minute pre-recorded workshop) CLICK HERE

  • Reconnect (10 week, online Trauma Sensitive Yoga course to help you connect to body resources to support you on you therapy journey) CLICK HERE

  • Remembrance (online, monthly 75minute Trauma Sensitive Yoga space + library of previously recorded spaces) CLICK HERE

Please be aware these invites are OPTIONAL and it is up to your discretion to decide what/if any will be a support for you. These options (and others) can be found via the link here

You are also welcome to speak to your Psychologist about any of these to decide further what could be supportive for you.

There is also a free resources page which you are welcome to check out and use as needed at www.mindfullycurious.org/resources

Fees

The cost of a consultation (50 minutes) is $270 (unless otherwise agreed to with your Psychologist), which is payable at the end of the session by direct deposit or EFTPOS/Square. If you have obtained a Mental Health Care Plan from your GP, upon the completion and full payment of the session, your psychologist will provide you with a receipt to claim your partial rebate of $96.65. This claim can occur online, using the Medicare app or in a center. If payment is to be covered by a third party, please discuss your individual circumstances with your psychologist.

Please note Mindfully Curious Psychologists do not provide legal/court reports however you are able to request Attendance letters for the session.

Late fee / Outstanding Invoice Policy

Please be aware that you will be asked to provide your credit card details when filling out the New Client Form. The use of your card will only be used if payment has not been finalised within 7 days of your appointment (or unless otherwise agreed upon).

If failure to pay for consult after 6 months from appointment date a Medicare webclaim will be made in your name meaning Mindfully Curious will receive a bulk bill fee for the appointment. Please be aware this would be a one off circumstance and if you choose to rebook with Mindfully Curious in the future an upfront payment of the full fee will be required prior to the appointment.

Please note your card and bank account details are encrypted, tokenised and stored securely by Braintree for Australia. Both are subsidiaries of PayPal, one of the world's largest payments providers. Neither your practitioner nor anyone at Halaxy (our software management system) can access your card details.

Cancellation Policy

If, for some reason you need to cancel your appointment, as much notice as possible is the best policy. However we understand this may not always be possible so where you can please give Mindfully Curious at least 24 hours (1 business day) notice, otherwise you will be charged the cost for the session unless the appointment spot is able to be filled within the time notice provided. There is a waiting list and, as such, Mindfully Curious will do what is reasonably possible to avoid this fee (such as filling the appointment with another client and sending an email reminder before the appointment date) but ultimately it is your responsibility to remember and attend your appointments as per scheduled.

BUSINESS DAYS

  • Monday

  • Thursday

*for example, if needing to cancel appointment on Monday, please provide notice Thursday before.

If, after reading this form you are at all unclear about any of the information provided, please discuss further with your psychologist and clarify any information in your session or via email at info@mindfullycurious.org.

Last updated: Thursday 18 July 2024