Treatment Consent Form Conditions of Psychological Treatment

Confidentiality: As part of your psychological, emotional, spiritual assessment, Adelaide Counselling & Psychotherapy Group Pty Ltd will collect and record personal information relevant to your current situation. You may access the material recorded in your file upon request, subject to the exceptions in National Privacy Principle 6, copies of which are available on request.

All personal information gathered by your Counsellor remains confidential except:

– If your file is subpoenaed by a court; or

– Failure to disclose the information would place you or another person(s) at risk; or

– Your approval has been obtained (e.g., in order to discuss your care with your Partner, Parent, GP).

Fees: The fee for a sixty-minute session is $125, payable on the day. A concession fee of $69 is available if you are a student, hold a concession card or are experiencing financial difficulty (limited availability). Relationship Interventions are between 70 and 90 minutes and $195/session.

Payment is due at the time of consultation. Adelaide Counselling reserves the right to pause consultations if an account remains outstanding.

Cancellation of Appointments: If you are unable to attend your appointment, please call the practice on “Call Us” so that the appointment can be offered to a client on the waitlist. For cancellations with less than 24 hours’ notice there is a fee of 50% of the appointment fee.

These policies are in place to be fair to all our clients and our services, as our appointments tend to be in high demand. We thank you in advance for your co-operation.

If there is anything written on this page that you do not understand, please discuss it with your therapist before you sign.

Mr Michael Mavromatis Counsellor

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