CLIENT INFORMATION AND CONSENT FORM

1. Purpose and Nature of Psychological Services

As part of providing a psychological service, Rachel McGregor Psychologist will collect and record personal information relevant to your circumstances. This enables accurate assessment, diagnosis, treatment planning, and evidence-based psychological care in accordance with the AHPRA Code of Conduct and the APS Code of Ethics.

Services may include psychological assessment, diagnostic evaluation, psychotherapy, counselling, consultation, and/or referral. The nature, goals, potential risks, expected benefits, and likely duration of treatment will be explained to you, and may evolve over time in collaboration with you.

Engagement in psychological services is voluntary, and you may withdraw at any time.

2. Collection, Use, and Storage of Personal Information

Personal information collected may include your name, contact details, medical and psychological history, session notes, test results, payment details and information relevant to your treatment.

This information is used to:

provide safe, effective psychological care
maintain accurate clinical records
ensure continuity and quality of treatment

Records are stored securely and accessed only by your psychologist or authorised personnel in accordance with privacy legislation. Administrative staff may access limited identifying information only when required for scheduling, billing, or file management.

A full Privacy Policy is available on request.

3. Record Retention

Clinical records are retained in accordance with legal and ethical requirements:

Adults: typically for at least 7 years after the final contact
Clients under 18: until the client reaches age 25

Longer retention may occur if professionally necessary.

4. Consequences of Not Providing Information

If you choose not to provide relevant information, this may affect your psychologist’s ability to offer safe and effective care. You may request to use a pseudonym unless identification is required by law or affects treatment practicality.

5. Risks, Benefits and Alternatives

Psychological treatment can involve benefits (e.g., improved coping, symptom relief, insight) and can also involve risks (e.g., emotional discomfort, temporary symptom worsening). Alternatives—including other practitioners or treatment approaches—may be discussed at any time.

Please raise any concerns you have throughout therapy.

6. Confidentiality, Limits, and Disclosure

a. Confidentiality

All personal information is private and confidential and managed in accordance with the Australian Privacy Act (1988) and relevant health legislation. Information is shared only when necessary and only with your consent, except where legally required.

This includes:

session notes
assessments
reports
correspondence
any disclosed personal information

b. Mandatory Limits to Confidentiality

Information may be disclosed without your consent when:

There is a serious and imminent risk to your life, health, or safety, or that of another person.
There is suspected abuse, neglect, or risk of harm to a child or vulnerable person, as required by law.
A court subpoenas your file, requiring release of notes or psychologist testimony.
Disclosure is required by law, including reporting serious criminal intent or when health professionals must report an impaired practitioner.
Your psychologist is unable to provide services (illness, incapacity) and minimal information must be shared to ensure safe continuity of care.

If disclosure is required, you will be informed where safe and appropriate.

c. Disclosures with Your Consent

With your written permission, information may be shared with:

your GP or psychiatrist
other mental health or health professionals
family members or carers
case managers, NDIS coordinators, or relevant agencies
legal or other professionals directly involved in your care

You may revoke or revise your consent at any time.

d. Standard Correspondence

Correspondence with your referring doctor (e.g., GP, psychiatrist) is standard practice and included within this consent.

e. Interpreter or Translator

If required, an interpreter or translator may be arranged. Interpreters are required to adhere to professional confidentiality and ethical standards.

7. Cultural Safety, Inclusivity, and Client Diversity

Your psychologist is committed to culturally safe, respectful, and inclusive practice. This includes recognition of the cultural rights of Aboriginal and Torres Strait Islander peoples, and responsiveness to diverse gender identities, sexualities, disabilities, religious/spiritual beliefs, and cultural backgrounds.

You are encouraged to discuss any cultural or identity-related needs that may affect your care.

8. Telehealth and Electronic Communication

Psychological services may be offered via telehealth (phone or video), which has been endorsed by Australian health authorities as an appropriate mode of service delivery.

a. Telehealth Security and Privacy

All privacy obligations apply to telehealth. While secure, encrypted platforms are used, complete security of digital communication cannot be guaranteed.

b. Your Responsibilities for Telehealth Sessions

To support privacy and therapy effectiveness, please:

choose a private, quiet location where you will not be overheard
avoid public Wi-Fi
ensure a stable internet connection
use headphones when privacy is limited
position your device securely and minimise background noise

You may withdraw telehealth consent at any time.

9. Recording, Notes, and Use of De-identified Data

Your psychologist maintains clinical notes according to ethical and legal requirements.

NOVONOTE: NovoNote is an AI Scribe tool used by Psychologists in Australia. It is an automated note-taking tool that helps me focus on your care during sessions. NovoNote transcribes the session and creates a summary for your client file. The transcript is deleted and is not included in your file, and session audio is never saved. NovoNote operates on a secure server in Australia, uses encryption and security protocols, and does not use your data to train AI models. You can withdraw your consent to its use at any time. For more information, please see NovoNote’s security information: https://novopsych.com/novonote-security/

De-identified case material may be discussed in professional supervision to support treatment quality.

By signing this form you consent to your de-identified case material being used in professional supervision. This consent expires 2 years from the date of signing.

If you have any concerns about your case material being discussed in professional supervision please speak to your Psychologist.

10. Fees, Billing, and Cancellations

a. Fees

The Australian Psychological Society suggested fee for psychological services from 1 July 2025 until 30 June 2026 for a standard psychological consultation of 46-60 minutes is $318. This fee is suggested only and Psychologists are able to vary this fee at their discretion.

The fee for Rachel McGregor Psychologist is:

Standard session (50 minutes): $250.00
NDIS rate: $252.99
Concession rates may be available upon request (200.00 per session)
Specialist Letter Preparation 95.00
Report Preparation 250.00 per hour

Medicare rebates are processed following payment when applicable.

Fees will be reviewed and updated on a yearly basis in July in line with APS guidelines and Medicare, NDIS and other government funding indexation. Fees may change at any time.

PAYMENT POLICY: Payment is required on the day of your consultation. Further appointments may be suspended until any outstanding balance has been paid. This policy does not apply to third-party payments, including NDIS plan-managed and WorkSafe payments.

b. Cancellations

Please provide at least 24 hours’ notice for cancellations or rescheduling.
Late cancellations or non-attendance may incur the full session fee.

11. Conflicts of Interest and Professional Boundaries

Your psychologist will avoid conflicts of interest and maintain professional boundaries. If a potential conflict arises, it will be discussed collaboratively and managed in line with ethical guidelines.

TWO FAMILY POLICY: For child referrals, please also read the attached Two Family Policy, which explains the practice’s policy for working with separated families. Please review this policy, as it outlines the practice’s approach should family circumstances change.

12. Crisis and Emergency Situations

Your psychologist is not a crisis service.
If you or someone else is at immediate risk, please contact emergency services or a crisis support line such as:

Lifeline: 13 11 14
Beyond Blue: 1300 22 4636
Kids Helpline: 1800 55 1800

13. Access to Your Information

You may request access to information held about you. Access may be limited only where permitted by law. Your psychologist will discuss available options, including providing a written summary or arranging a file-review appointment.

14. Data Breach Response

In the event of a data breach, the practice will follow its data breach response plan and take reasonable steps to minimise any risk of harm.

15. Feedback, Complaints, and Professional Oversight

You may provide feedback or lodge a complaint at any time.

Information on how to make a complaint to the Psychology Board of Australia / AHPRA is available on request. Your psychologist can assist you with accessing appropriate channels.

16. Acknowledgement and Consent

By signing below, you confirm that:

you have read and understood this form
you have had an opportunity to ask questions
you provide informed consent to receive psychological services
you understand the limits to confidentiality
you may review or withdraw consent at any time

17. Review of Consent

Consent will be reviewed periodically (e.g., annually or if your treatment needs change).

Service Item

Duration

Price