TPP Therapy Agreement & Telehealth Consent Policy

The therapy agreement is between you (or the legal representative of your child) and your therapist and is used to facilitate a safe and conducive environment for therapy to take place between you and your therapist.

Psychotherapy

At The Psychology Practice, your therapist will work alongside you to help you with the problems you bring into therapy by applying scientifically validated approaches based on research and recommended practices. It is a collaborative treatment based on the relationship between you and your therapist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral and non-judgmental.

As it is a process that requires significant commitment on your part, we encourage you to raise and discuss any questions you may have about the therapy process with your therapist.

Telehealth service

Beyond face-to-face therapy sessions, The Psychology Practice also offers the option of a telehealth service. Should you choose to explore this option at any point during your therapy journey, your therapist will discuss the appropriateness of this service whilst keeping your unique treatment needs in mind.

The Psychology Practice will be responsible for the cost associated with our platform used to conduct telehealth services.

To access telehealth consultations, you will need access to a quiet, private space; and the appropriate device, i.e. smartphone, laptop, iPad, computer, with a camera, microphone and speakers; and a reliable broadband internet connection (WiFi). Please be informed that a telehealth consultation may be subject to limitations such as an unstable network connection which may affect the quality of the therapy session.

The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology used. To support the security of your personal information this practice uses Platomedical.com which is compliant with the standards for online security and encryption.

Consent to receive psychological services by telehealth video consultations [OPTIONAL]

I have been provided with information about the service including the limitations to privacy and confidentiality.

I agree that in circumstances where my therapist is concerned about my welfare and is unable to contact me, permission is provided for my therapist to contact my next of kin as indicated in the registration form.

[ ] I would like to explore the option of tele-health services.

Confidentiality

Psychotherapy often involves the disclosure of sensitive and personal information, so confidentiality is paramount. To protect your right to privacy, the information disclosed to your therapist will remain confidential.

In order to keep track of important and relevant themes/issues covered in therapy and to provide an informed psychological service to you, your therapist may document what happens in session. You may also be asked to complete questionnaires to facilitate a better understanding of your circumstances and to monitor progress in therapy. These will be kept securely to ensure that your privacy is protected.

Disclosure of personal information

All personal information gathered by your therapist during the course of psychotherapy will remain confidential except when:

1. It is subpoenaed by a court, or disclosure is otherwise required or authorised by law; or

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

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

c) Disclose the information in another way; or

d) Disclose to another professional or agency (e.g. your GP, treating psychiatrist) and disclosure of your personal information to that third party is for the purpose of treatment

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.

Safety Planning

In times of crisis or emergencies, we may have to contact your next-of-kin for your (or your child’s) personal safety. We may also refer you (or your child) to agencies or services that may better support you during these situations. However, we would endeavour to discuss these plans with you beforehand.

Therapy sessions and Fees

A typical individual therapy session is 50 minutes in duration, while for couple’s or family therapy it is 80 minutes. Please allow yourself ample time to travel down, and get settled in for each session.

In the event that you are late for your appointment, your therapist can only see you up till the end of your scheduled appointment time and the full session fee will be charged. Upon commencement of the session, the full session fee is payable and is non-refundable.

The session fee is payable at the end of the session by PayNow, Bank Transfer or major Credit Cards. Your official invoice will be emailed to you once payment is confirmed.

If payment is covered by a third party payer, kindly describe details:

________________________________________________________________________

Termination/Feedback/Complaints

You have the right to terminate services at any point in time. Your experience is important to us and regarded as an important part of the therapy process as well. Hence, you are encouraged to discuss with your therapist any concerns you may have.

Appointment Scheduling

Upon making an appointment with us, you will receive an appointment confirmation via email with your appointment details. This serves as both a follow-up and reminder that the agreed upon time slot has been reserved for you. We seek your assistance to acknowledge the appointment by clicking on the confirmation link provided.

Please note that non-confirmation of the appointment (i.e. not clicking on the email confirmation link) will not be accepted as a form of cancellation or as an indication that you will not be attending the session. We also do not accept cancellations via third parties for clients above the age of 18 out of respect for your privacy. This includes family members/ partners/ friends.

To cancel or reschedule your appointment, please contact us directly via phone/ WhatsApp/ SMS/ email at any time. We seek your understanding that all emails and messages sent to us outside of office hours will be responded to on the next business day.

24-Hour Cancellation Policy

We have a 24-hour cancellation policy for all appointments, and strictly adhere to this out of respect to our therapists and clients.

If you are unable to attend your appointment, we request for you to inform us at least 24-hours in advance, otherwise the FULL session fee is charged and payment will be due on the same day of cancellation. Rescheduling of sessions within the same week are subject to each therapist’s availability.

We understand that things may come up at the last minute preventing you from attending your appointment. However, as a professional practice, we need to adhere to our cancellation policy in order to uphold a fair, consistent, and reliable service for our therapists and our clients.

A late cancellation, late rescheduled appointment, or failure to attend your appointment is a loss to:

1. The client (i.e. you/your child) who is delaying your therapy progress

2. Another client who needs the appointment

3. Your therapist who has spent time preparing for the session, committed to setting time aside for you, as well as loss of income

If you can’t make it to an appointment, instead of cancelling and incurring a cancellation fee, please consider the suitability of keeping the scheduled appointment but swapping to a video consultation instead.

In the event of illness and family emergencies that sometimes occur, we will not charge a cancellation fee in such cases. A medical certificate may be required (at our discretion) for the fee to be waived.

For clarity, please note that the following examples are not considered “family emergencies” under this policy:

  • A meeting called at work or any changes to work rosters or travel requirements

  • A school, sports or extracurricular event

  • A family activity or holiday

  • Changes to the availability of a babysitter or childcare service

Although we accept that such events may be beyond your control and can be genuine reasons for late cancellation, we seek your understanding to uphold our cancellation policy for these types of circumstances and a cancellation fee would still apply. Fee waivers will be reviewed on a case by case basis.

Please note that in the event that the cancellation fee is not paid, we reserve the right to pursue legal action for reimbursement of the outstanding fee.

[ ] I acknowledge that I have read and understood the 24-hour cancellation policy.

Informed Consent

I, (print your name in Block Capitals) …………………………………………………….., have read and understood the information in this Consent Form and have discussed any outstanding questions with the practice/psychologist. I agree to the above conditions for face-to-face and/or telehealth psychological services to be provided by my therapist at The Psychology Practice.

Client signature ……………………………………………...............…………. Date ……./………/……..

Please note: If there is anything in this agreement you are unsure of, please discuss it with your therapist.

The Psychology Practice Therapy Agreement & Telehealth Consent