Psychological service 

As part of providing psychological treatment to you, Zest Clinical Psychology 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. If you are registered with 'My Health Record', Zest Clinical Psychology may view this record as required throughout the time you attend psychological treatment.  

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Purpose of collecting and holding information 

Your personal information is gathered as part of your assessment and treatment. It is kept securely and compliant with the relevant legislative and regulatory requirements in Australia and, in the interests of your privacy, used only by your psychologist and authorised personnel (as necessary). 

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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. 

 

Disclosure of personal information 

All personal information gathered by Zest Clinical Psychology during the provision of the psychological service will remain confidential except when: 

1. It is subpoenaed by a court, or disclosure is otherwise required or authorised by law; or 

2. Failure to disclose the information would in the reasonable belief of Zest Clinical Psychology place you or another person at serious risk to life, health or safety; or 

3. Your prior approval has been obtained to provide/receive treatment information or to discuss treatment (e.g. GP, another health professional, family member etc.)

 

In the event that unauthorised access, disclosure or loss of your personal information occurs, Zest Clinical Psychology will activate a data breach plan and use all reasonable endeavours to minimise any risk of consequential serious harm.

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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. Zest Clinical Psychology 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 Halaxy, which is compliant with the Australian standards for online security and encryption.

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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. 

 

Fees 

The cost of a consultation (between 50-55 minutes) is $200, which is payable at the beginning or end of the session by EFTPOS, cash or credit card (only Visa and MasterCard). Rebates may apply depending on the referral. 

 

Cancellation Policy 

If, for some reason you need to cancel or postpone your appointment, please give the psychologist a minimum of 24 hours’ notice, otherwise you may be charged a cancellation fee, which is 75% of the full fee. Medicare rebates do not apply when a session is not attended.

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When you need immediate assistance in case of a crisis, please call triple zero (000) for emergency services or go to your local hospital's emergency department. Telephone helplines such as Lifeline (1300 11 14) are available 24 hours a day, 7 days per week. 

 

Please note: If, after reading this form you are at all unclear about any of the information provided, please discuss this with your psychologist. 

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I have read and understood this Consent Form. I agree to the above conditions for the psychological service provided by Zest Clinical Psychology. 

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Date: [Current Date]