Consent details
The purpose of this consent form is to ensure you are aware of relevant processes and procedures related to seeking services at Inner Melbourne Clinical Psychology (IMCP).
Terms of consent form
Your consent will remain valid indefinitely unless you choose to withdraw it or there is a significant change to this consent form. From time to time, this consent form may be updated. For the most current version, please contact our Support Team.
You have a right to withdraw this consent at any time by telling Melody or putting your request in writing. You cannot withdraw consent for a service that has already occurred. Melody can discuss with you any implications of withdrawing consent.
Collection and storage of your information
As part of providing a service to you, Melody will need to collect and record personal information that is relevant to your current situation. This information will be a necessary part of the assessment and treatment that is conducted. This information is retained in order to document what happens during sessions and enables Melody to provide a relevant and informed service. All client information is stored in accordance with the Victoria Health Records Act (2001). Your information is only accessed by your Melody and as required, by authorised staff and personnel engaged by the practice, in accordance with IMCP’s applicable policies and procedure.
From time to time, we may introduce new technology (such as practice management software, accounting systems or AI tools) to help us deliver services and manage the practice. If we do, we will take all reasonable steps to ensure your privacy and confidentiality are protected.
In the event that any unauthorised access, disclosure or loss of your personal information occurs IMCP will activate its data breach plan and use all reasonable endeavours to minimise any risk of consequential serious harm.
Feedback and complaints
We are always looking for ways to improve our service. We welcome feedback about your experience with Melody, as well as our clinic more generally. For feedback or suggestions get in touch with our Director, Dr Jacqueline Baulch by emailing: info@innermelbpsychology.com.
Information sharing
If you would like Melody to discuss your information with another health professional or other relevant person, they will request you complete a written consent form.
Any information that is disclosed by you to our admin team may be shared with Melody if we feel it is relevant to your therapy.
In order to provide an ethical and effective service, therapists engage in professional supervision and peer consultation throughout their career. This may involve discussing clients in a non-identifiable way.
Clients have a right to access their information. If you would like to do so, please get in touch with our Support Team and we can talk you through the process.
Confidentiality
All information disclosed within sessions is confidential and may not be revealed to anyone without written permission except where disclosure is permitted or required by law. These situations include but are not limited to: (a) when there is reasonable suspicion of abuse to a child or to a dependent or elder adult; (b) when a client is at risk of harm to others; (c) when a client is at risk of harm to themselves; or (d) when disclosure is required pursuant to a legal proceeding.
Emergency services
Please be aware that Inner Melbourne Clinical Psychology does not provide emergency services. If you require immediate assistance, please call 000 or for phone support call Lifeline on 13 11 14.
Third party payment and reports
Please note that we only see clients through Medicare, private health insurance or privately. We are unable to see clients through TAC, Workcover, Victims of Crime, NDIS or any other third party. We also do not provide court reports or one-off assessments. If you are seeking support of this nature, please ensure you make this clear to us prior to your first appointment as unfortunately we will need to suggest external services.
Session length
Sessions are approximately 50 minutes.
SMS reminders
SMS reminders are sent approximately 72 hours before appointments. Please do not respond to this reminder as this is an automated service that comes from a computer. If you need to cancel or reschedule your appointment call or email our Support Team (email is preferred).
48 hour cancelling and rescheduling policy
If you cancel or change your appointment within 48 hours, unless there is an emergency you will need to pay the full fee for this session. Regardless of whether an appointment is attended, Melody spends time planning client sessions, so we feel it is important that they are remunerated for this time. By giving us more than 48 hours of notice you allow us enough time to offer your appointment to other clients who may be on a waiting list for an appointment.
Email and SMS communication
By signing this form, you consent to communication with Inner Melbourne Clinical Psychology and Melody via email and SMS. Please be aware that email and SMS are not fully secure forms of communication and while we take steps to protect your privacy, we cannot guarantee the security of information sent or received in this way. If you would prefer not to be contacted by email or SMS, please let us know at the time of completing this form.
Fees
You were informed about fees at the time of booking your first appointment. If you have any questions about this, please reach out to our Support Team.
Sessions with Melody do not attract a Medicare rebate, so if you have a Medicare referral you would not be able to use this.
Payment
Payment is required on the day of your session. You can pay with credit card or EFTPOS.
Appointments overseas
We are not able to see clients who are living overseas. If you are planning on going overseas for a short period, you will first need to speak with Melody about whether they can continue to see you while you’re overseas. Medicare rebates are not able to be processed for appointments that occur while you are outside of Australia.
Telehealth services
Telehealth sessions are any sessions conducted via phone or online video.
Limitations of Telehealth services
The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology used.
A Telehealth consultation may be subject to limitations such as an unstable network connection which may affect the quality of the psychology session. In addition, there may be some situations for which Telehealth is not appropriate or effective. Melody will consider and discuss with you the appropriateness of ongoing Telehealth sessions.
Like face-to-face sessions it is important that Telehealth sessions are conducted in a private and confidential space (unless otherwise agreed upon), where you are the only person present.
Kindness towards our team
We ask that you treat our team with kindness at all times. We have a zero-tolerance policy for aggressive behaviour.
Completing this form
If you understand and agree with what is outlined above, please complete this form prior to your session with Melody. If you have any questions that you would like to ask before completing the form, please bring these along to your first session and Melody will be happy to answer them.