1. The assessment is completed by a psychologist (not a psychiatrist). Psychologists can not prescribe medication but can diagnose ADHD.

2. The Pre-Screening Survey will need to be completed before your appointment.

3. You will need to provide the contact details of 3 people who know you or your child well. For adult assessments this includes someone who knew you well as a child. For child/adolescent assessment this includes 2 teachers. These contacts will need to complete surveys to corroborate ADHD symptoms. Not providing this information may affect the outcome of your assessment.

4. Please note that an ADHD diagnosis is not a guaranteed outcome of the assessment; conclusions will be based on the information gathered and clinical judgement. Further assessment or treatment may be suggested as an outcome of your assessment.

5. The contractor psychologist engaged with ADHD Therapy Australia is your treating "psychologist" responsible for your care, you are "the client" (yourself or person you are organising services for), and Changes Psychology is the admin and billing service "provider" that is only responsible for processing clients' bookings, billing and client administration only on behalf of your treating psychologist. By signing this agreement you are agreeing to the provision of services under this arrangement.

6. Privacy - ADHD Therapy Australia and Changes Psychology take your privacy seriously. We work like a virtual clinic office, collecting and managing personal and medical information digitally from you and your psychologist, which naturally includes sensitive health information. We collect, use and (where appropriate) store this information, which includes health information, in order to facilitate appointments with psychologists; manage payment, medicare and insurance claims; and manage records regarding your appointments. The provider's handling of personal information involves some processing of client information by employees and contractors, some of which are based overseas. We manage your information in accordance to ethical guidelines and respective Australian Privacy Laws. For more about privacy, and who to contact if you have questions or complaints regarding privacy, please refer to the providers full privacy policy here changespsychology.com.au/privacypolicy

7. Confidentiality of information collected for Psychological Services - You can be assured that all personal information gathered by this form and within psychological sessions will remain confidential and secure. However, it is important to know there are exceptions in which psychologists are mandated by the law to wave confidentiality.

This can occur in one or more of the following scenarios;

A. The information you have provided to your psychologist is subpoenaed (officially requested) by a court of law
B. Failure to disclose certain information would place you or another person at serious risk of harm.
C. Psychologists are by law mandated to report all cases of child abuse and mistreatment.
D. Your prior consent has been obtained to;
- i) Provide a written report to another professional or organisation. e.g. A letter to a GP or Lawyer
- ii) Provide details to a third party (only if written consent was given prior)
E. Non-clinical details such as medicare numbers, referring doctors names, appointment times and other information considered important for administrative tasks may be accessed by administrative staff in the course of there work. Where possible, you will be advised that a notification will be made, however, this may not be practical at all times due to safety or legal reasons. If you have any concerns that the information you would like to share may incriminate yourself or another, please notify your therapist and they will discuss this concern with you prior to giving details and/or other implicit information.

8. Medicare Rebates NO Medicare rebates can be claimed for Assessments. Only for therapy sessions.

9. Session fees - Assessment fees are $540 to cover all aspects of the assessments including the clinical interview session, provision of the report and feedback on report results.

10. Cancellation Policy - SMS reminders for appointments are sent to clients 2 days before their scheduled appointment, and email reminders sent 1 day prior to sessions. Cancellation fees are charged if less than 48 hours notice is given, and the full scheduled fee is payable if you fail to give more than 48hours notice that you cannot attend. In the case of patients with multiple cancellations, to book an appointment a non refundable advanced payment may be required to book an appointment. If a refund is requested, the fee for processing the payment and the refund will be deducted from the refund.

11. Your treating psychologist will not provide information, reports or documentation for medico-legal or family court related purposes unless required to by law, under a subpoena or by a court order. Exceptions to this include situations where your treating psychologist is a mandatory reporter.

12. Parenting plans - if there is a parenting plan in place we require the parent or person engaging in treatment to meet all requirements of the plan, it is not our responsibility to share information with other parents or stakeholders.

Jasmine Jack Psychologist

Fees/Services