Hamish Johnson Clinical Psychologist Ltd
Client Consent Form

CLIENT CONSENT FORM

As part of providing a psychological service, I will need to collect and record personal information that is relevant to your current situation. This information will be a necessary part of the psychological assessment and treatment that is conducted. You do not have to give all your personal information, but if you don’t, this may mean the psychological service may not be able to be provided to you.

You have the right to refuse any treatment or withdraw your consent to treatment at any time.

Purpose of collecting and holding information

The information is gathered as part of your assessment, diagnosis and treatment, and is seen only by Hamish Johnson Clinical Psychologist Limited, including staff.  The information is retained in order to document what happens during sessions, and enables me to provide a relevant and informed psychological service. 

Access to Client Information

At any stage you as a client are entitled to access the information I have about you that is kept on file, unless the relevant legislation provides otherwise. I am happy to discuss with you appropriate forms of access. 

Confidentiality

All personal information gathered by Hamish Johnson Clinical Psychologist Limited during the provision of the psychological service will remain confidential and secure except where

(a) it is subpoenaed by a court, or

(b) I consider that you or another person is at serious and/or imminent risk of harm; or

(c) your prior approval has been obtained to:

               i) Provide a written report to another professional or agency (e.g., GP); or

               ii) Discuss the material with another person (e.g., parent, employer); or

               iii) If disclosure is otherwise required or authorised by law. 

Terms and Conditions

I have read, understood and signed the accompanying Terms and Conditions for HJCP Ltd regarding payment and late cancellation. 

Please Note: If you do not understand any of what is written, please discuss this with me.

ACKNOWLEDGEMENT

NOTE: By clicking SUBMIT you agree to our consent content.

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