TERMS AND CONDITIONS

My Practice Counselling Solutions – Counselling Agreement

Client Services Agreement

CLIENT CONSENT FORM

Welcome to My Practice Counselling Solutions, a counselling practice located in Melbourne, Australia. We are committed to supporting your personal growth and transformation through respectful, creative, and ethical counselling services. As part of providing our services to you, our practitioners may need to collect and record your personal information. This information is essential for guiding your treatment and is securely stored in compliance with Australian Privacy Laws. If you have any questions regarding your privacy, please feel free to discuss them with your treating practitioner.

Therapy Process and Termination

Participating in therapy can lead to numerous benefits, but it requires effort and commitment from you. While counselling can be challenging at times, it may help you overcome unhealthy thoughts and behaviors and improve your relationships. Please note that contacting My Practice Counselling Solutions does not automatically initiate a therapy/counselling relationship.

The therapy/counselling process begins after the initial evaluation/session and completion of required forms in your first session. During this assessment, we will determine whether we are the right fit for your therapy/counselling needs and if you wish to continue working with My Practice Counselling Solutions. We reserve the right to decline clients if we believe more specialized services are required, if there are conflicts of interest that could affect your therapy, if the services you need fall outside our expertise, or if more intensive services are necessary. In such cases, we will provide you with appropriate referrals for your consideration.

You have the right to withdraw from therapy at any time, and termination of services can be initiated by either you or My Practice Counselling Solutions. If termination occurs, we will offer discharge recommendations or referrals as needed. If you cancel or miss scheduled appointments without contacting us for more than 30 days, it will be considered a termination of treatment. Once therapy is terminated, the counsellor will have no further obligation to you.

For further inquiries or to learn more about our services, please reach out to your treating practitioner.

Serious Threat to Health or Safety:

According to the Child Protection Act 1999 and the Mental Health Act 2016, if you communicate to My Practice Counselling Solutions a specific and imminent threat to cause serious bodily injury or death to an identified or identifiable person and My Practice Counselling Solutions believe you have the intent and ability to carry out that threat immediately or imminently My Practice Counselling Solutions is legally required to take steps to protect third parties. These precautions may include

warning the potential victim(s), or the parent or guardian of the potential victim(s), if under 18,
notifying a law enforcement officer, or
seeking your hospitalization.

My Practice Counselling Solutions may also use and disclose medical information about you when necessary to prevent an immediate, serious threat to your health and safety.

Exceptions to Confidentiality: There are some situations where we might be legally or ethically bound to disclose information. These include situations involving:

A risk of suicide
Threats of violence that pose immediate safety concerns
Incidents of child abuse or neglect
Throughout our collaboration, we’ll revisit and emphasize these principles of confidentiality. We encourage open dialogue about any concerns or questions you might have regarding your privacy.

Confidentiality

Please be assured that all information provided in the process of consultation is strictly confidential. Only the assigned practitioner can access your session notes, and our administration staff see limited information to support you with bookings. Other than the special circumstances outlined below, no information may be released to others without the written consent from you or your guardian.

These special circumstances include the following:

Where a court orders the release of client information for legal purposes
Failing to disclose the information would place you or another person in serious or imminent risk.
Where the treating practitioners are seeking peer support from other practitioners in the clinic to provide you with the best service
Your prior approval has been obtained to provide a written report to other agencies (e.g., GP, Lawyer) or discuss the material with another person, e.g., parent, employer, teacher.
If the disclosure is required by law.

Limits on Legal Proceedings

Given the confidential nature of counselling, you should know that many personal matters are discussed openly. As such, you, your lawyer, or any representative cannot summon anyone from My Practice Counselling Solutions to provide evidence in legal cases, like divorces or other disputes, or ask for the release of therapy records unless agreed upon in advance. If we’re required to testify due to a court order, a fee of $400 per hour will apply.

Court Records Disclosure

If you’re part of legal proceedings in Victoria, remember that your therapy session details and records are legally protected. They won’t be shared without your written consent or a court directive. If we receive a legal request for records, you’ll be notified. Pending a decision about such a request, the related records might be sealed and handed to the Clerk of Court.

In Victoria, some nuances apply to the confidentiality of therapy records, especially in child custody or abuse cases. Please be aware that in specific scenarios where child abuse is involved, your mental health is in question, or a judge deems the information crucial, therapy records might not stay private. Also, in criminal cases where the therapy evaluations are ordered by the court or intended for third parties, confidentiality may not be guaranteed. You’ll be informed ahead of time if this is the case.

Communication and Digital Interaction Policy

Telephone Communication:
At My Practice Counselling Solutions, brief phone conversations focused on scheduling, changing, or confirming appointments, as well as addressing straightforward queries, are free of charge. However, if a phone call extends beyond 20 minutes or involves additional services like specialized report preparations or consultations, they will be billed at the prorated 50-minute session rate (either for individual or couple/family).

Social Media, Messaging, and Email Protocols:

Social Media: We maintain official accounts under the name “My Practice Counselling Solutions.” You are welcome to interact with these accounts, but we urge you to exercise caution and discretion, especially when sharing personal information. To protect confidentiality and uphold the professional nature of our relationship, we do not accept friend requests from current or former clients on any social media platform. Engaging with clients on such platforms can inadvertently blur the boundaries of our therapeutic relationship.

Messaging: We strongly advise against using social media messaging platforms to communicate with us regarding treatment or scheduling. Such platforms are not secure, and your messages might not be attended to promptly. For any immediate or important concerns, reaching out via phone or direct email is the most suitable approach.

Email: By booking a counselling session, you grant permission for My Practice Counselling Solutions to use the email you provide for all correspondences directly linked to our service offerings. This includes but isn’t limited to invoicing, appointment scheduling, reminders, and service-related follow-ups. This consent will also cover any future email address updates you provide.

Your trust is paramount, and our policies are designed to ensure that our relationship remains professional, confidential, and focused on your well-being.

Fee Structure and Payment Policy (In accordance with Victorian regulations)

Payment and Fee Structure:

a. Fixed Fee: Each 50-minute counselling session has a fixed fee, which must be settled prior to the session’s commencement.

b. Payment Methods: Payments can be facilitated through online bank transfer, Stripe, or directly using BSB and Account number details. We prefer payments through PayPal or Stripe, which will include any associated processing fees.

c. Credit Terms: Please note that My Practice Counselling Solutions does not offer credit terms to its clients. All payments must be processed before the scheduled session, unless previously discussed and arranged differently.

d. Processing Fee for Credit Cards: Payments made via credit cards will attract a nominal processing fee, which will be applicable even for no-show appointments.

Cancellation and No-Show Policy:

a. Cancellation: If you need to cancel or reschedule a session, we kindly request a minimum of 24 hours’ prior notice. Failure to provide sufficient notice may result in a full session fee charge, as per our Therapist-Client Services Agreement.

b. No-Show Appointments: In the event of a no-show appointment, the full session fee will be charged, and this charge will be made to your original payment method, whether credit card or bank transfer, along with a minor processing fee.

Data Security:

We understand the importance of data security and strive to protect your payment information. We use secure and reputable payment gateways to process transactions and do not store your credit card information on our servers.

Confidentiality:

All payment-related information will be treated with strict confidentiality and used solely for the purpose of processing your payments. We do not share your payment details with any third parties, except as required by law.

Changes to the Privacy Policy:

We reserve the right to update or modify this section of our Privacy Policy to reflect changes in our payment practices or to comply with legal requirements. Any changes will be effective upon posting the revised version on our website.

By continuing to use our services, you signify your acceptance of this Privacy Policy, including the payment terms outlined in this section. If you have any questions or concerns about our payment policies, please don’t hesitate to contact us at info@mtpracticecounselling.com.au

Client Agreement:

As a client or family member, I (Client’s Name) will:
Treat staff and other clients with courtesy and consideration at all times.
Respect the needs and opinions of all clients and staff. Keep My Practice Counselling Solutions informed of any changes in your personal situation, such as where I live and any changes in medication.
Work cooperatively with My Practice Counselling Solutions regarding issues arising during the development and delivery of support and activities covered by this agreement.
Pay all fees owing by the due date where required.

Complaints and Disputes

My Practice Counselling Solutions recognises that clients and their carers/guardians have a right to provide feedback to our staff and management to raise suggestions, resolve grievances, commend good performance, and encourage all clients to speak up when they are not happy. If the client has a complaint, the My Practice Counselling Solutions Complaints Policy will be followed. A copy of our Complaints Policy can be provided on request.

Your acceptance of this booking/appointment with My Practice Counselling Solutions above indicates that you have read this agreement for services fully and that you understand and agree to its contents. By accepting the booking, making payment and checking ‘yes’, you agree that details entered will be the electronic representation of my signature for all purposes when I use them on documents, including legally binding contracts – just the same as a pen-and-paper signature.

Last update: July 2023