Your Information

    Emergency Contact

    Please provide one alternate contact in case of emergency. 

    Medicare and Health Fund Details

    Please provide Medicare card details if you have a GP Mental Health Care Plan would like us to claim Medicare on your behalf. Please make sure that you have registered your bank account details with Medicare. 

    PSYCHOLOGIST – CLIENT AGREEMENT
    Purpose of collecting and holding information
    Kinexus psychology is committed to ensuring that personal information collected is dealt with in accordance with the Information Privacy Principles contained in the Information Privacy Act 2009. As part of providing a psychological service to you, Kinexus Psychology will need to collect and record personal information from you that is relevant to your situation as part of the assessment, diagnosis and treatment of your condition. The information gathered is seen only by the psychologist, and is retained in order to document what happens during sessions, and enables the psychologist to provide a relevant and informed psychological service. You do not have to give all your personal information, but without the relevant information, this may mean that Kinexus Psychology may not be able to provide psychological services to you.

    Access to Client Information
    At any stage you as a client are entitled to access to the information about you kept on file, unless the relevant legislation provides otherwise.  Your psychologist may discuss with you appropriate forms of access. 

    Confidentiality
    All personal information gathered by the psychologist during the provision of the psychological service will remain confidential and secure except where:
    It is subpoenaed by a court, or Failure to disclose the information would place you or another person at serious and imminent risk; or Your prior approval has been obtained to provide a written report to another professional or agency. eg. a GP or a lawyer; or discuss the material with another person, eg. a parent or employer; or if disclosure is otherwise required or authorised by law.

    Fees
    The current fees recommended by the Australian Psychological Society (APS) are set at $238.
    The cost of a standard consultation (usually 55 minutes) is $200, which is payable at the end of the session by cash, or EFTPOS. Any rebate will be pay directly to your account.

    Cancellation Policy
    If, for some reason you need to cancel or postpone the appointment, please give me at least 24 hours notice, otherwise you will be charged $100 for the cost for the session.

    Charter for Clients of Psychologists
    The Charter explains your rights as a client of a psychologist (https://www.psychology.org.au/Assets/Files/APS-Charter-for-clients.pdf)

    Crisis Service
    Kinexus Psychology is unable to provide out of hours crisis service. If you are in crisis and need help urgently, please call: i) Lifeline 13 11 14;   ii) Beyond Blue 1300 22 4436;   iii) Kids Help Line 1800 55 1800; 
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    I have read and understood the above Psychologist-Patient agreement.  I agree to these conditions for the psychological service provided by Kinexus Psychology.