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CROSSROADS THERAPY 
Psychologist consent and registration form

Please read the following terms and conditions in regards to our psychological services.

Upon reviewing the consent form, please complete the registration form at the bottom of the page.

Privacy and confidentiality

In providing psychological services to you, Crossroads Therapy and Support Services needs to collect relevant personal information; including your name, contact details, medical history and other relevant information. This collection of personal information will be a necessary part of the psychological assessment and treatment process. Information shared during sessions is confidential and cannot be disclosed without written permission, except as permitted or required by law. These situations include (a) reasonable suspicion of abuse to a child, dependent, or elder adult, (b) client harm to others or themselves, or (c) as required by legal proceedings.

If you would like your psychologist to share information with another health professional or other relevant person, completion of a written consent form will be required. 

To maintain their registration, psychologists engage in professional supervision and peer consultation while ensuring client confidentiality.

 

Collection and storage of Information

When delivering psychological services, your psychologist will gather and document personal information relevant to your current situation. The main purpose for collecting this information is to provide quality psychological services. The information you provide will also be used for: (a) administrative purposes for the practice, (b) billing purposes, and (c) disclosure of information to other professionals, agencies or individuals in accordance with the confidentiality guidelines. This information is an essential component of the psychological assessment and treatment process and is retained to document session details and facilitate informed psychological practice. All client information is stored in compliance with the Victoria Health Records Act (2001).

 

Cancellation and rescheduling policy

To reschedule or cancel your appointment, please provide at least 48 hours notice. Our clinic has a 48-hour cancellation and rescheduling policy. Changes within this timeframe, unless due to an emergency, will incur the full session fee. If you fail to attend your appointment, you will incur a full session cancellation charge. By giving us more than 48 hours notice you allow us to accommodate waitlisted clients. For Monday appointments, please contact us by Thursday morning, as our reception closes at 5:00 pm on Fridays. Note that Medicare or private health insurance rebates cannot be claimed for unattended sessions.

 

Fees and rebates

Information on fees was provided when you booked your initial appointment. If you have a referral from a GP or psychiatrist for a Mental Health Treatment Plan, you qualify for a Medicare rebate of $93.35 per session. Once we've processed your payment and received all necessary paperwork, we can manage your rebate through our online system. According to Medicare, these funds should appear in your bank account within 2 to 3 business days.

In the event of significant lateness to your session, in accordance with Medicare guidelines, a reduced or no rebate may be applicable. Please note that rebates are not applicable for sessions that are unattended.

 

Payment

You will be advised of the session fee at the time of making the booking. Full payment is taken by the psychologist following each session via Stripe, a secure online payment method. At Crossroads Therapy and Support Services, we do not offer bulk billing. 

 

Mental Health Treatment Plan

Under a Mental Health Treatment Plan, Medicare requires regular updates to the referring GP or psychiatrist. These updates are typically communicated via online fax, and in order to comply with Medicare requirements your psychologist or our support team may need to make contact with Medicare.

 

Third party payment and reports

Our services are exclusively available for clients covered by Medicare, private health insurance, NDIS or private paying. We are unable to accommodate clients under Workcover, Victims of Crime, TAC, or any other third-party. Additionally, we do not provide court reports or one-off assessments. If you require services falling under these categories, please communicate this before your initial appointment.

 

Session length

Each therapy session is approximately 50 minutes.

 

Telehealth services

Telehealth sessions are conducted via phone or online video. All online therapy sessions are end-to-end encrypted, ensuring that only you and your psychologist have access to the call via your own unique link.

 

Limitations of telehealth services

You agree and acknowledge that the online platform has third party dependencies which may affect its availability. A Telehealth session might have limitations, such as a potentially unstable network connection that could impact the quality of the psychology session. Crossroads Therapy and Support Services has no means of controlling the availability of such dependencies and is not liable for any such interruptions. 

There may be situations where Telehealth is deemed inappropriate or less effective. In such cases, your psychologist will evaluate and discuss the suitability of continuing Telehealth sessions with you.

Similar to face-to-face sessions, it is crucial for Telehealth sessions to be conducted in a private and confidential space, ensuring you are the sole individual present.

 

No recording at Crossroads Therapy and Support Services

Unauthorized audio or video recording of clinical sessions by clients is strictly prohibited, and any violation of this policy will lead to an immediate termination of clinical services. We place utmost importance on respecting your privacy and uphold the highest standards for safeguarding your confidential information. Unauthorized recording by clients may result in your private information being stored on potentially unsecured servers, with the possibility of third-party access beyond our control.

Furthermore, breaching the no-recording policy introduces a strain on the therapeutic alliance and trust within the therapist-client relationship, rendering consultation and treatment less effective. We appreciate your consideration in adhering to and respecting this policy. Should you wish to discuss this policy further, feel free to reach out to your psychologist or the Clinic Director.

Email reminders

Email reminders are sent 72 hours before appointments. If you need to cancel or reschedule please call or email our support team for changes. Please note the 48 hour cancellation policy.

 

Emergency services

Crossroads Therapy and Support Services does not provide emergency support. In case of emergencies, please call 000 or one of the services listed below. 

Local Crisis Centre Lines - 24 hours / 7 days a week.

  • Lifeline (Crisis support): 13 11 14

  • Kids Help Line (5-25 years): 1800 551 800

  • Safe Steps (Family violence): 1800 015 188

  • Suicide Call Back: 1300 659 467

Appointments overseas

If planning to go overseas for a short period, consult your psychologist about continuing sessions. Medicare rebates are not applicable for appointments that occur whilst outside of Australia.

 

Respect towards our team

At Crossroads Therapy and Support Services, we maintain a zero-tolerance policy for aggressive behaviour. We request that you treat our team with kindness and respect.

 

Completing this form

Please ensure that this form is completed prior to your initial session. Should you have any questions, these can be discussed with your psychologist during the session itself.

Consent form

Emergency contact details

Medicare rebate details

Thanks for submitting!

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