Rates

Charges for individual counseling are: $150 These sessions are 60 minutes in length.

These rates are subject to change with the changing market and clients will be notified of any changes in rates. Group therapy rates vary by practitioner.

Insurance

We accept Private insurance from :

Payment

Cash/ Bank Transfer prior to the session.

Thank you for valuing our services by agreeing with these terms.

Psychotherapy is a working cooperative relationship between you and your counselor. Each member of this cooperative
relationship has certain responsibilities. Your counselor will contribute their knowledge, expertise, and clinical skills. You,
as the client, have the responsibility to bring an attitude of collaboration and a commitment to the therapeutic process.
While there are no guarantees regarding the outcome of the treatment, your commitment may increase the likelihood of a
satisfactory experience.

Fees and Appointments

Appointments are 60/45 minutes in length and take place on weekly/fortnight basis. Your counselor holds your specific hour
for you each week/fortnight. If you are unable to keep an appointment, please cancel as soon as possible. You will be
responsible for payment of missed sessions. If you are able to reschedule your appointment within xxx working days, it
will not count as a cancellation. We ask that you pay prior to your session each time. We reserve the right to suspend
therapy if services are rendered and not paid.

Confidentiality

Communication between you and your counselor is confidential. This means that your counselor will not discuss your
case orally or in writing without your expressed written permission (please see the following section on “Training and Supervision”).

Your counselor has an ethical and legal obligation to break confidentiality under the following circumstances :

1. If there is a reason to believe there is an occurrence of child, elder, or dependent adult abuse or neglect.
2. If there is reason to believe that you have serious intent to harm yourself, someone else, or property by a violent act you may commit.
3. If you disclose that you knowingly develop, duplicate, print, download, stream, or access through any electronic or digital media or exchanges, a film, photograph, video in which a child is engaged in an act of obscene sexual conduct.
4. If you introduce your emotional condition into a legal proceeding.
5. If there is a court order for release of your records.

Availability and After Hours Emergencies

Counselors check for voice mail messages during normal business hours. Messages left outside of normal hours of operation will be picked up the next business day. If you have an emergency that needs immediate attention you may need to
seek assistance at the nearest emergency services department.

Child Care Release

We do not provide childcare and do not allow children inside the Counselling room.

Additional Rights and Responsibilities

In addition to your right to confidentiality, you have the right to end your counseling at any time, for whatever reason and without any obligation, with the exception of payment of fees for services already provided. You have the right to question any aspect of your treatment with your counselor. 

You also have the right to expect that your counselor will maintain professional and ethical boundaries by not entering into
other personal, financial, or professional relationships with you.

We reserve the right to discontinue counseling at any time including, but not limited to, a violation by you of this Consent for Treatment, a change or reevaluation of your therapeutic needs.

Our ability to address those needs, or other circumstances that lead us to conclude in its sole and absolute discretion that your counseling needs would be better served at another counseling facility. Under such circumstances, we will suggest an appropriate counselor(s) or counseling agency.

CONSENT TO USE OR DISCLOSE HEALTH INFORMATION FOR TREATMENT, PAYMENT, HEALTH CARE OPERATIONS, AND ACKNOWLEDGEMENT OF RECEIPT OF THE PRIVACY ACT 1988

In the course of providing services to you, we may create, receive, and store individually identifiable information, including information that relates to health care and payment for health care (“Personal Information”). It is often necessary to use and disclose this Personal Information in order to treat you, to obtain payment for our services, and to conduct health care operations involving our office.

We have a The Privacy Act 1988 that describes these uses and disclosures. As described in our Notice of Privacy Practices, the use and disclosure of your Personal Information for treatment purposes not only includes care and services provided here, but also disclosures of your Personal Information as may be necessary or appropriate for you to receive follow-up care from another health care professional. Similarly, the use and disclosure of your Personal Information for purposes of payment may include, for example, the submission of this information to a billing agent for processing claims or obtaining payment and/or submission of claims to insurers.

When you sign this consent document, you expressly agree that we can and will use and disclose your personal Information to treat you, to obtain payment for our services, and to operate our practice. You can revoke this consent in writing at any time unless we have already treated you, sought payment for our services, or performed health care operations in reliance upon our ability to use or disclose your information in accordance with this consent. We can decline to serve you if you elect not to sign this consent form.

You also acknowledge, by your signature below, that you have received a copy of our The Privacy Act 1988.

I HAVE READ THIS CONSENT AND UNDERSTAND IT. I CONSENT TO THE USE AND DISCLOSURE OF MY PERSONAL INFORMATION FOR PURPOSES OF TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS.

I ALSO ACKNOWLEDGE THAT I HAVE RECEIVED A COPY OF THE PRIVACY ACT 1988.