Consent for Counselling/Nutrition consultation via zoom - telehealth service

As part of providing a Counselling/Nutrition service to you, the counselling & Nutrition and staff at Life In Balance Group need to collect and record personal information from you that is relevant to your situation,such as your name, contact information, medical history and other relevant information as part of providing counselling/nutritional services to you. This collection of personal information will be a necessary part of the assessments and treatment that is conducted. A detailed description of how your personal information is managed, how you can access your personal information, and how to lodge any concerns or complaints is available in our Privacy Policy.

 

Disclosure of personal information

Personal information gathered as part of this service will remain confidential except when:

1. it is subpoenaed by a court; or

2. failure to disclose the information would place you or another person at serious risk to life, health or safety; or

3. your prior approval has been obtained to

a) provide a written report to another professional or agency. e.g., a GP or a lawyer; or

b) discuss the material with another person, eg. a parent, employer or health provider; or

c) 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.

 

Use of therapy session materials:

Life In Balance staff, counsellors & nutritionists will not make recordings of our sessions or use material from our sessions for purposes other than delivering a service to you. We will seek your written consent if we wish to use material for other purposes (such as consultation with colleagues).

 

We ask you to respect the privacy of Life In Balance Group staff, counsellors & Nutritionist, by agreeing not to make recordings of our sessions and not to use materials from our sessions for purposes other than therapy. If you wish to record sessions or use session material for other purposes, you must seek our consent to do so.

 

Provision of a telehealth – video call service (zoom):

Where appropriate the service may be provided by videoconferencing. You are

responsible for the costs associated with setting up the technology needed so you can access the video call/telehealth services. Life In Balance Group will be responsible for the cost of the call to you and the cost associated with the platform used to conduct telehealth services.

 

To access video call zoom / telehealth consultations you will need access to a quiet, private space; and the appropriate device, i.e. smartphone, laptop, iPad, computer, with a camera, microphone and speakers; and a reliable broadband internet connection.

Because you may be in varied locations for each of our videoconferences or phone calls, we will require you to provide your location at the commencement of each session.

 

The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology used. To support the security of your personal information this practice uses Zoom.

 

Limitations of Video call zoom- telehealth:

A telehealth consultation may be subject to limitations such as an unstable network connection which may affect the quality of the counselling/nutritional session. In addition, there may be some services for which zoom is not appropriate or effective. Your counsellor will consider and discuss with you the appropriateness of ongoing telehealth sessions.

 

Fees:

The cost of an Initial consultation $ 160 (approx “50” minutes) with a Follow-up sessions $ 160 (approx 50 mins). These fees are in line with the PACFA recommended Fees. 50% or the fee is payable at the time of booking & the remainder is payable on the day of the service. Payments are accepted  (online payment, online invoice / direct deposit / Bpay). Counselling & Nutritional consultations are not eligibility for Medicare rebates.

 

Cancellation Policy

If you need to cancel or postpone your appointment, please give Life In Balance Group at least 24 hours notice, by calling 1300 232 166 or emailing Lifeinbalancegroup@gmail.com otherwise you will be charged a cancellation fee equivalent to the service booked.

 

Consent to receive Counselling/Nutritional services by telehealth:

I have read and understood the information in this Consent Form and have discussed any

outstanding questions with my counsellor/nutritionist. I agree to the above conditions for telehealth counselling services to be provided by Life In Balance Group.