School Psychology
Consent Form

Terms & Conditions

A psychologist from Blooming Bees Psychology will be appointed to the client based on availability and the client’s needs/wants. This will be the client’s practicing therapist. I Understand that sessions may vary in time depending on the client’s needs and the school timetable. All sessions will be bulk billed unless otherwise previously agreed to.

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Purpose of Collecting and Holding Information

As part of providing services to the client, the psychologist will need to collect and record personal information, which is part of an assessment, diagnosis, and treatment of the client. The information is retained in order to document what happens during sessions and enables the therapist to provide a relevant and informed service.

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 Access to Client Information 

At any stage, the client is entitled access to information about them that is kept on file, unless the relevant legislation provides otherwise.

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Release of Information

In providing treatment, the psychologist may need to obtain and collect collateral information about the client from other relevant sources, such as GP’s and the school. I understand and agree to the free flow of information between the school, GP, other health professionals, and the treating psychologist: (name all parties consenting to)

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Confidentiality

All personal information gathered by the therapist during the provision of the service will remain confidential and secure, except where:

1. It is subpoenaed by a court; or

2. Failure to disclose the information would place the client or another person at serious and

   imminent risk; or

3. Prior approval has been obtained to:

   1. Provide a written report to another professional or agency, e.g., a GP or a lawyer; or

   2. Discuss the material with another person, e.g., a parent or employer;

4. If disclosure is otherwise required or authorised by law

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 Cancellation Policy

 If for some reason, the client needs to cancel or postpone the appointment, please give at least 24 hours notice, otherwise you may be billed the session fee in whole (private or medicare).

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Submission

By submitting this form, you agree to the above, and confirm you have read and understood this consent form. With your signature, you also agree to the above conditions for the psychological services provided.