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Consent Form

Psychological Facility

As part of providing an online counselling service to you, Brigitte Regnaut 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 that is conducted. You do not have to give all your personal information, but if you do not, this may mean the psychological service may not be able to be provided to you.

Purpose of collecting and holding information

The information is gathered as part of the assessment, diagnosis and treatment of the client's condition, and is seen only by the psychologist. The information is retained in order to document what happens during sessions, and enables the psychologist to provide a relevant and informed psychological service.

Once the service is completed, your information will be securely archived electronically and in locked filing cabinets for a period of 7 years. This is a standard practice required by law. The information will then be destroyed either by electronic deletion or shredding.

Access to Client Information

At any stage you as a client are entitled to access to the information about you kept on file, unless the relevant legislation provides otherwise. The psychologist may discuss with you appropriate forms of access.

Confidentiality

All personal information gathered by the psychologist during the provision of the psychological service will remain confidential and secure except where:

1. It is subpoenaed by a court, or
2. Failure to disclose the information would place you or another person at serious and imminent risk; or
3. Your prior approval has been obtained to

    - Provide a written report to another professional or agency, e.g. a GP or a lawyer; or
    - Discuss the material with another person, eg. a parent or employer, if disclosure is otherwise required or authorised by law.

Terms and Conditions for Online Counselling Interventions

Whilst there are many benefits to the therapeutic use of technology, there are also some limitations. Before signing this consent form, make sure you have read and understood the "About Online Counselling" page on this website.

Latitude Online Counselling Services does its best to secure online communication from security breaches. Users however must be aware that there are risks in transmitting information over the internet. Communication may be at risk of being intercepted, read or modified.

Brigitte Regnaut uses a private office and is not observed by anyone when in session with you or when responding to your emails. Equally it is your responsibility to ensure the privacy of all your communications with Latitude Online Counselling Services.

It is your responsibility to ensure the confidentiality and safety of all emails and transcripts of onlineconversations. You must be aware that deleted files can still be accessed.

You explicitly agree not to forward email messages or other electronic communications from Brigitte Regnaut to other persons, except in circumstances where this has been agreed in advance with Latitude Online Counselling Services. You may not copy and paste parts of emails, advice and recommendations out of context or pass on the advice to a third party.

It is your responsibility to:
• Conduct your sessions in a way that will maximise your ability to benefit from it (e.g. not beunder the influence of drugs or alcohol)
• Give Brigitte Regnaut relevant information in order for her to help you
• Behave in a respectful manner while online. Latitude Online Counselling Services reserves the right to terminate service to you if this is the case.

Fees

The cost of a 50 minutes consultation or of 3 email exchange is AUD $100, which is payable via PayPal prior to the session.

Cancellation Policy

If, for some reason you need to cancel or postpone the appointment, please give me at least 24 hours notice, otherwise you may be charged the cost for the session.




Please Note: If, after reading this page you are at all unsure of what is written, please discuss it with the psychologist.

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