Consent Form

Consent Form

Your Psychologist 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 treatment.


Any personal information received about you is strictly confidential. However, there can be exceptions, for instance, when:

  1. You or someone else may be at serious risk of harm;

  2. You have given permission to:

    • Discuss your information with another person. e.g. another professional;

    • Provide a written report to another professional or agency;

  3. Criminal activity is disclosed that may result in imprisonment or;

  4. It is subpoenaed by Court.

Please advise if there is information you do not wish to be disclosed to others. Under Medicare, Workers Comp and WentWest correspondence with the Doctor is required.

Under the Code of Ethics, a Psychologist cannot add a consumer/client/patient as a Facebook friend. Any request to be added will be respectfully declined by your Psychologist.

Hugs –  you will need to request this. If you are sick, this will be respectfully declined.


  • $180 – with a Mental Health Care Plan for Face-to-Face and Telehealth – 1 hour. $100 for 30 minutes.

  • NB: if you commit to 1 hour, you will be charged $180 regardless of the time taken (subject to the psychologist’s discretion)

A receipt will be provided for you to claim the rebate through Medicare Online;

  • No fee for approved WentWest or Workers Compensation Claims;

  • From $950.00 ($300 prepayment required) for Court Reports or other Reports;

  • From $100.00 – letters for work, university, or other reasons outside of session;

  • Cancellations require at least 24 hours notice otherwise a $50 cancellation fee be requested before another appointment will be scheduled.

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