Robbie Spence

Clinical Counsellor

robbiespence.com.au

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CLIENT CONSENT FORM

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Counselling Services

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As part of providing a Counselling service to you, your counsellor, Robbie Spence, will need to collect and record personal information from you that is relevant to your current situation. This information will be a necessary part of the assessment and counselling that is conducted.

Confidentiality

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All personal information gathered by the counsellor during the provision of the counselling service will remain confidential

and secure except when:

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1. It is subpoenaed by a court of law

2. Failure to disclose the information would place you and/or another person at risk of harm

3. Your prior approval has been obtained to …

a. provide a written report to another professional or agency eg a GP, other health care professional, lawyer or

supporting agency such as Workcover or Third Party Insurance agency

b. discuss the material with another person eg referring GP, parent, partner or employer.

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Fees

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Fees are currently $120 per hour and are payable following your session. You will receive an invoice with link to payment.

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Charter for Clients of Counsellors

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As a client of a counsellor, you have a right to expect that:

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• You will be treated with respect

• You will receive a clear explanation of the service you will receive

• Your consent for any service will be sought by the counsellor prior to the service commencing and as it progresses

• You will receive an explanation about the nature and limits of confidentiality surrounding the service

• You will receive competent and professional service

• You will receive a clear statement about fees

• You will be clear about the outcome that you and the counsellor are working toward

• You will receive a service free from sexual harassment

• You will be shown respect for your cultural background and language tradition