Client-Clinician Agreement: Terms of Service & Consent Forms

The purpose of this document is to ensure that you fully understand the Terms of Service in which you are entering into with Laneways Psychology Canberra for the provision of psychology services, as well as ensuring that you provide us informed consent prior to undertaking treatment of any kind.

1. Psychological service

As part of providing a psychological service to you, Madeleine Davies of Laneways Psychology Canberra needs to collect and record personal and sensitive information from you that is relevant to your situation, such as your name, contact information, medical history and other relevant information as part of providing psychological services to you.

This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted. The handling and storage of your personal and sensitive information is bound by our Privacy Policy. 

2. Individual Therapy

Therapeutic counselling is broad in nature, and varies depending on the personalities of client and clinician in equal measure, as well as the challenges presented for support. In support of you, we may employ different therapeutic methods to support you in ameliorating problems you present in session. Success in therapy depends on a collaborative effort between client and clinician, including your participation both in and in between sessions.

There are risks and benefits included in therapy, and sessions often include exploring unpleasant or uncomfortable topics. As a result, you may at times experience uncomfortable feelings, including frustration, anger, guilt or sadness. For those who participate in therapy, however, there are benefits and ways to work toward your goals. For some, therapy leads to better relationships, for others they may focus on reduction in distress, for others still they will seek to focus on a range of goals, including these and others. There are no guarantees in therapy, but together we can achieve our best in working toward these efforts.

Initial sessions are focused on assessment, by the end of which we will be able to give you an indication of what our work together will likely include, and a treatment plan for you to decide on whether this is the right next step for you. You should evaluate this, and feel free to ask questions about this treatment plan to ensure you feel comfortable taking this step. We encourage you to continue to ask questions and provide feedback on your experience along the way.

It’s important to remember not every clinician will be the fit for every client, that’s ok. Our goal is always to ensure the clinician working with you is a good fit for you. If you or your clinician feel at any time that it’s not the right fit, we can refer to where an alternative option is clear, or refer back to your GP for support.

3. Animal Assisted Therapy 

As part of your therapy sessions, a professionally trained and assessed therapy dog may be used to enhance your treatment. We provide this as an additional service; however, there is no additional fee for this service, and therapy sessions will continue in the event of the dog’s absence due to illness, injury or other animal welfare concern. While the therapy dog is highly trained and socialised, interacting with animals carries inherent risks. These include, but are not limited to, allergic reactions, zoonotic diseases (illnesses transmitted from animals to humans), and potential physical injuries, such as scratches or bites. Participation in therapy sessions involving a therapy dog is entirely voluntary. You may withdraw your consent to interact with the therapy dog at any point without affecting your treatment. By agreeing to participate in therapy with the assistance of a therapy dog, you acknowledge and agree to the following: 

3.1. I confirm that I have disclosed any known allergies or medical conditions that may prevent me from safely interacting with the therapy dog(s). 

3.2.  I understand that while therapy dogs undergo routine veterinary care to maintain their health, there are some illnesses that may be transmitted between humans and dogs. 

3.3.  I understand that therapy dogs are trained and assessed for working with people, but I acknowledge the inherent risks of interacting with animals, including potential injuries. 

3.4. I agree to follow all instructions provided by the animal handler to ensure safe and positive interactions with the therapy dog. 

3.5. I have disclosed any pre-existing phobias or fears related to dogs. 

3.6. I understand that my participation in animal-assisted therapy is voluntary and I may withdraw consent at any time. Please note: It may not be safe for people who are immune-suppressed to work with therapy animals.

If you are immune-suppressed, please consult your physician prior to participating in Animal-Assisted Services. Written medical clearance is required to ensure your safety in interacting with a therapy dog. 

4. Collecting and Use of Personal  Information

Your personal information is collected  as part of your assessment and treatment is kept securely and, in the interests of your privacy, used only by your psychologist, the authorised personnel of the practice (as necessary) and any authorised service provider in accordance with our policies and procedures. Your personal information may be collected using hardcopy forms, Outlook, face-to-face interactions with Laneways Psychology Canberra, or through referrals, correspondence and medical reports from other health practitioners.

Your personal information is retained to document what happens during sessions and enables the psychologist to provide a relevant and informed psychological service to you. A more detailed description is provided in the clinic’s Privacy Policy, which can be obtained by contacting admin@lanewayscanberra.com.au or by clicking on the link in this document. The Privacy Policy contains information about how to access and seek correction of your personal information, and how to lodge a complaint about our management of your personal information.

Your information is stored securely as per Australia's privacy laws. It is only accessed by your psychologist and as required, by authorised staff and personnel engaged by the practice, in accordance with the practice’s applicable policies and procedures. Please see the Privacy Policy, for further information on how your information is stored. 

5. Use of Technology and Digital Security

5.1. Telehealth services: Laneways Psychology Canberra offers individual therapy via telehealth (phone or video) for clients who require it. If sessions occur via telehealth, you should be in a quiet, private space. Technology errors may occur, and telehealth carries some additional privacy and security risks, including potential interruptions, data breaches, or unauthorised access. You may choose to opt out of telehealth at any time.

5.2. Data Storage, Electronic Systems & Security: Your data may be stored electronically on secure platforms. Laneways Psychology Canberra utilises Halaxy for scheduling and records. 

5.3. Use of Artificial Intelligence: Laneways Psychology Canberra utilises Heidi Health as an AI transcription tool for in session notes. As per the advertised policy and procedures of Heidi Health, no audio recordings or identifiable information is stored. Your consent to utilise such tools will be obtained prior to their implementation and you may decline or remove your consent to the use of such tools at any time in your engagement of services at Laneways Psychology Canberra. There is a small risk associated with any digital processing tool, which we manage carefully to minimise exposure.

6. Consequence of not providing personal information

If you do not wish for your personal information to be collected in a way anticipated by this letter or the Privacy Policy, Laneways Psychology Canberra may not be able to provide the psychological service to you. You may request to be anonymous or to use a pseudonym, unless it is impracticable for Laneways Psychology Canberra to provide psychological services to you or if Laneways Psychology Canberra is required or authorised by law to deal with identified individuals. Provision of service through a third party, for example workers compensation insurance, may also require identification. In most cases it will not be possible for you to be anonymous or to use a pseudonym.

7. Access to client information

At any stage you are entitled to access your personal information kept on file, subject to exceptions in the relevant legislation. The psychologist may discuss your different possible forms of access.

8. Disclosure of personal information

All personal information gathered by the psychologist during the provision of the psychological service will remain confidential except when:

8.1. it is subpoenaed by a court, or disclosure is otherwise required or authorised by law; or

8.2. failure to disclose the information would, in the reasonable belief of your psychologist, place you or another person at serious risk to life, health, or safety; or

8.3. your prior approval has been obtained to:

a. provide a written report to another professional or agency. e.g., a GP or a lawyer; or

b. discuss the material with another person, e.g., a parent, employer, health provider or third-party funder; or

c. disclose the information in another way; or

d. disclose to another professional or agency (e.g., your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected.

Psychologists are required to consult with colleagues and receive supervision from time to time to ensure the delivery of safe, effective, and competent psychological services in line with professional standards. If your information is shared in this context, every effort will be made to de-identify your information so that you remain anonymous. If it becomes necessary to share information that could identify you, your psychologist will request your consent either through a written release of information form or verbally. You have the right to decline or revoke this consent at any time.

Your personal information is not disclosed to overseas recipients, unless you consent, or such disclosure is otherwise required by law. Your personal information will not be used, sold, rented, or disclosed for any other purpose.

If unauthorised access, disclosure, or loss of a client’s personal information occurs, Laneways Psychology Canberra will activate its data breach response plan and use all reasonable endeavours to minimise any risk of consequential serious harm.

9. Terms and Conditions 

A copy of our Terms and Conditions can be found by clicking the link in this document, or by visiting our website, or by emailing admin@lanewayscanberra.com.au

10. Working with Vulnerable People

A copy of our Working with Vulnerable People policy can be accessed by clicking the link in this document, or by visiting our website, or by emailing admin@lanewayscanberra.com.au      

11. Fees

The standard clinical rate for a 50 minute session with Madeleine Davies is $295.00.

Any additional correspondence (face-to-face, phone, email) with other professionals, agencies and organisations (at the request of a client) or consultations with the psychologist outside of the organised appointment, will be charged at the agreed upon rate prior to commencement. This includes treatment summary reports, letters of support, and/or request for accommodations for workplaces or educational institutions. Fees for additional correspondence and services must be paid prior to the release of the materials.

12. Cancellation Policy

A copy of our cancellation policy can be obtained by clicking the link in this document, or by contacting admin@lanewayscanberra.com.au 

At Laneways Psychology Canberra we understand that life can be unpredictable, and sometimes you may need to change or cancel your appointment. However, due to the demand for our services and the time allocated for each client as part of agreeing to our Terms of Service, you are agreeing to be bound by this cancellation policy.

The Policy should be read in conjunction with our Terms and Conditions. If you do not have a copy of these, please request one and one will be provided to you. By engaging our services and/or by booking an appointment, you agree to be bound by this Policy and for the fees and charges outlined in this Policy to be charged to you through your nominated payment method.

12.1. Cancellations or changes to an appointment must be made via email to admin@lanewayscanberra.com.au at least 48 hours (2 clear business days) prior to your scheduled appointment time. This allows us the opportunity to offer your time slot to another client in need. Business days are Monday to Friday, excluding public holidays. For example, to cancel a Monday appointment at 9am, please provide notice by 9am Thursday to avoid any cancellation fees. Please see below the associated fees with late cancellation.

• Greater than 48 hours notice (on business days) - No cancellation fees apply 

• Less than 48 hours notice but greater than 24 hours notice (on business days) - 50% of your appointment fee applies.

• Less than 24 hours notice (on business days) or “Did not attend” (DNA) - 100% of your appointment fee applies.

12.2. Late Cancellations and No-Shows. If you cancel your appointment within 48 hours (without 2 clear business days) of the scheduled time, or do not attend (a “No-Show”) with no notice or less than 24 hours’ notice, you agree to be charged the full fee associated with that appointment. If you reschedule your appointment with less than 48 hours' notice,  the fee in item 11.1 above will be charged. This fee will be charged to your account and must be paid before your next session.

12.3. Emergency Cancellations. We understand that emergencies may arise. In the case of illness or urgent situations, please contact us as soon as possible, and we will consider the circumstances on a case-by-case basis.

12.4. Repeated Cancellations. Frequent cancellations or No-Shows may result in us needing to reassess your ongoing treatment. In some cases, we may request that you provide a deposit for future sessions. If this is the case, you will be informed in writing of our determination and course of action moving forward through your treatment.

12.5. Late Arrival. If you arrive late for your session, your session will still end at the scheduled time, and you will be charged the full fee. Your psychologist reserves the right to not engage in the session if more than 20 minutes has lapsed since the scheduled appointment time as there may not be enough time to engage in a session whilst adhering to APS Code of Conduct and Medicare standards.

12.6. Fees. All cancellation fees will be invoiced to you directly, and payment is required prior to scheduling any further appointments. We reserve the right to suspend our services to you until any outstanding cancellation fees are paid.

12.7. Appointment Reminders. We will send  a reminder SMS 4 days prior to your appointment and a reminder email 2 days prior to your appointment. However, it is ultimately your responsibility to remember your appointment time.

You are ultimately responsible for understanding the terms of cover for the particular benefit, scheme or health fund you are accessing our services through. Please be aware that cancellations are not eligible for a Medicare rebate. For NDIS clients, late cancellation fees are charged at 100% per NDIS guidelines. If you are engaging in our services and claiming WorkCover or Motor Vehicle Accident schemes, be aware that not all insurers will cover the fee of a cancelled appointment, regardless of the reason for cancellation. It is your responsibility to verify coverage with your insurer.

We appreciate your understanding and cooperation in allowing us to continue providing high-quality services to all clients. If you need to reschedule or cancel your appointment, please contact us at admin@lanewayscanberra.com.au, or utilise the Halaxy portal.                 

12. APS Charter for Clients of Psychologists

The attached Charter explains your rights as a client of a psychologist. This can also be accessed following this link.

13. Complaints 

If you have any concerns about your contact with our clinic, please discuss these with your psychologist, if you are able. If you would like to make a complaint, you are able to do so by contacting us via email at admin@lanewayscanberra.com.au. If you have concerns about the ethical or professional conduct of your psychologist, you may contact the Australian Health Practitioner Regulation Agency.

14. Consent  

In line with the Psychology Board of Australia Code of Conduct, this consent agreement will be reviewed every 12 months to ensure you continue to provide informed and voluntary consent. At the time of review, your psychologist will discuss the consent information with you and request a renewed consent form to be signed. Consent may also be reviewed earlier if there is a significant change to the nature, scope, or terms of the service.

You have a right to withdraw this consent at any time by telling your psychologist or putting your request in writing.  You cannot withdraw consent for a service that has already occurred. Your psychologist can discuss with you any implications of withdrawing consent.

By signing this form I confirm that I have read and understood these Terms of Service and Consent Form and have read and understood the Terms and Conditions for engaging Laneways Psychology Canberra for the provision of Psychological Services. I agree to be bound by these Terms of Service, Consent Form and Terms and Conditions of Laneways Psychology Canberra for the psychological service provided by Madeleine Davies.

Please note: If, after reading this form you are at all unclear about any of the information provided, please contact the psychologist prior to your appointment.