ABN: 98 174 696 513
CLIENT CONSENT FORM AND CONTACT DETAILS
As part of providing a counselling service to you, your counsellor, Eryka Rhodes will need to collect and record personal information from you that is relevant to your current situation. This information will be a necessary part of the assessment and treatment that is conducted.
You may access the material recorded in your file upon request, subject to the exception in National Privacy Act
All personal information gathered by the counsellor during the provision of the counselling service will remain confidential and secure except when:
- It is subpoenaed by court or,
- Failure to disclose the information would place you and/or another person at risk; or
- Your prior approval have been obtained to
a. provide a written report to another professional or agency. Eg GP or a lawyer or
b. Discuss the material with another person eg parent/other health professional
Privacy and security are carefully considered when accessing online counselling Services. Zoom is the current platform chosen to conduct online counselling consultations.
- All reasonable steps are taken to ensure adequate levels of security for the type of service being provided and vigilance in avoiding new threats to security as they arise in a rapidly changing field of practice and technology.
- During each consultation it is the responsibility of practitioner and client to monitor the privacy of the environment they are in. This includes being overheard or having someone else present without the knowledge or consent of the person at the other end of the communication.
- The practitioner will wear headphones for the duration of the consultation, and it is recommended the client does the same.
- It is the responsibility of both practitioner and client to advise if and when privacy is compromised, so it can be actioned immediately. Alternatives can be discussed for continuing the consultation by phone or continue with online when the privacy compromise is rectified.
- All forms are printed and securely stored. No data is kept or stored online.
The cost of a one hour consultation is $140.00 (GST incl) or $190.00 for 90mins which is payable prior to commencement of session by cash or direct debit.. Sessions that go over allotted time will be charged at $60 per half hour.
Please pay into:
Acct Name: E Yendell-Rhodes
BSB: 633 000
Acct No: 190 760 462
If, for some reason you need to cancel or postpone an appointment, please give at least 24hrs notice, otherwise a fee of $50 will need to be charged, and full fee charged for on the day cancelations.
Charter for clients and counsellor
The attached Charter explains your rights as a client of a counsellor