Consent Form

Consent Form

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PSYCHOLOGICAL/REHABILITATION SERVICES

As part of providing a psychological and/or rehabilitation service, including assessment and counselling to you, SmartRehab 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 psychological assessment and treatment and/or rehabilitation program that is conducted.  (Please refer to Smart Rehab’s Privacy Policy for more information.).  The duration of the Initial Consultation and consecutive consultations 50 minutes.

EMERGENCY

Should you require emergency services and are unable to contact Corinne Mioche, we advise you call your GP, Lifeline or the Redlands Mental Health Unit (Redlands Hospital, Cleveland).

ACCESS

You may access the material recorded in your file upon request, subject to the exceptions contained in National Privacy Principle 6.

CONFIDENTIALITY

All personal information gathered by the psychologist or other SmartRehab health professional during the provision of the service will remain confidential and secure except when and if:

  1. it is subpoenaed by a court; or
  2. failure to disclose information would place you or another person at risk; or
  3. release of that information to another psychologist, clinician or medical practitioner is needed as part of the referral process initiated by SmartRehab; or
  4. Release of that information is required when discussing my case and progress with my referring General Practitioner.

FEES (for Non-Workers Compensation and Non-NDIS cases)

The cost of a one-hour consultation is $150 which is payable at the end of the session by cheque, credit card, EFTPOS or cash.  Health fund rebates and Medicare rebates may apply. If you have a Mental Health Plan the minimum rebate that you will receive for each session is $87.45. (*you may receive a higher rebate if you have reached your Medicare threshold for this calendar year).

REFERRALS ‘

I welcome referrals, which signify feelings of satisfaction and trust in our services.  A referral from a General Practitioner is not necessary to access this service’.

Please Note: If, after reading this page you are at all unsure of what it means, please discuss with the SmartRehab psychologist prior to your session.