Forms for Clients

Mental Health Plan

Mental Health Plan or referral letter given by the GP with the following information:

• Patient’s name
• Patient’s date of birth
• Patient’s address
• Diagnosis
• List of any current medications
• Number of sessions the patient is being referred for.

Intake and Consent Form

Intake Form

Client’s details, contact details. Medicare provider number and GP’s or referral doctor’s details and permission to discuss information with third parties.

Consent Form 

As part of providing a psychological service through a Medicare bulk billed service to you or your child, b.kids Psychological Services requires to collect and record personal information from you that is relevant to your situation. This includes names, contact details, medical history and other relevant information which is a necessary part of the psychological assessment and treatment that will be conducted.

Purpose of collecting and holding information

Your personal information is gathered as part of your assessment and treatment under a Mental Health Care Plan which is kept securely and, in the interests of your privacy, used only by your psychologist and the authorised personnel of the practice (as necessary).

Your personal information is retained in order 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 practice’s “Privacy policy for management of personal information”, which can be obtained by contacting us through our email.

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.

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, b.kids Psychological Services may not be in a position to provide the psychological service to you.

You may request to be anonymous or to use a pseudonym, unless it is impracticable for b.kids Psychological Services to deal with you or your child, or if b.kids Psychological Services is required or authorised by law to deal with identified individuals.

In most cases it will not be possible for you to be anonymous or to use a pseudonym, however, if the psychologist providing the service agrees to you being anonymous or using a pseudonym, you must pay consultation fees at the time of the appointment and won’t be able to claim Medicare for this service.

Access to client information

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

Disclosure of personal information

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

1. it is subpoenaed by a court; or
2. failure to disclose the information would in the reasonable belief of b.kids Psychological Services place you or another person at serious risk to life, health or safety; or
3. your prior approval has been obtained to
   1. provide a written report to another professional or agency, e.g. a GP or a lawyer; or
   2. discuss the material with another person, e.g. a parent, employer or health provider; or
   3. disclose the information in another way; or
4. you would reasonably expect your personal information to be disclosed 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; or
5. disclosure is otherwise required or authorised by law.

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.

Fees

You give us permission to bill directly through Medicare. Other situations will be discussed case by case.

APS Charter for Clients of Psychologists

You can ask us for the APS Charter explaining your rights as a client of a psychologist.