Terms, Conditions & Consent Form
Consent to receive psychological services
Psychological service
As part of providing a psychological service to you, Kevin Vowles 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. This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted.
Purpose of collecting and holding information
Your personal information is gathered as part of your assessment and treatment, is kept securely and, in the interests of your privacy, used only by your psychologist and the authorised personnel of the practice (as necessary). Your personal information is retained in order to document what happens during sessions, and enables the psychologist to provide a relevant and informed psychological service to you.
Consequence of not providing personal information
If you do not wish for your personal information to be collected in a way anticipated by this letter or the Privacy Policy, Kevin Vowles may not be in a position to provide the psychological service to you.
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 the psychologist 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 Kevin Vowles place you or another person at serious risk to life, health or safety; or
3. your prior approval has been obtained to
• provide a written report to another professional or agency. e.g., a GP or a lawyer; or
• discuss the material with another person, eg. a parent, employer, health provider or third-party funder; or
• disclose the information in another way; or
• disclose to another professional or agency (e.g. your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected
Your personal information is not disclosed to overseas recipients, unless you consent or such disclosure is otherwise required by law. Your personal information will not be used, sold, rented or disclosed for any other purpose. In the event that unauthorised access, disclosure or loss your personal information occurs, Kevin Vowles will activate the data breach plan and use all reasonable endeavours to minimise any risk of consequential serious harm.
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. 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 Health Direct, which is compliant with the Australian standards for online security and encryption.
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
If payment is covered by a third-party payer (e.g., DVA, Bupa), then payment terms will be in accordance with the third party's agreement with Kevin Vowles.
Cancellation Policy
If you need to cancel or reschedule your appointment, you must give the psychologist at least 48 hours’ notice. Cancellation between 24 and 48 hours will incur a $100 cancellation fee payable by you before the next appointment is booked.
Cancellation less than 24 hours in advance will incur 100% cancellation fee. This fee is payable by you before the next appointment is booked. By accepting an appointment with Kevin Vowles, you are agreeing to this cancellation policy.
Consent to receive psychological services by telehealth
I [you the client] have been provided with information about the service including the limitations to privacy and confidentiality and I have agreed that in circumstances where the psychologist is concerned about my welfare and is unable to contact me permission is provided for the psychologist to contact my appointed emergency contacts.
APS Charter for Clients of Psychologists
The Charter explains your rights as a client of a psychologist and can be obtained by emailing Kevin Vowles at kevinpsychology@outlook.com
Crisis Support
Kevin Vowles cannot provide unscheduled crisis support. For such assistance you may try one of these services, or present to your nearest emergency department:
Kids Helpline - 1800 55 1800
MensLine Australia - 1300 78 99 78
Open Arms - 1800 011 046
LifeLine - 13 11 14
Suicide Call Back Service - 1300 659 467
Declaration (by submitting the online form with signature)
I [you the client] have fully read and understood this consent form. I agree to these terms and conditions for the services provided by Kevin Vowles.