Intake & Consent Form

Terms & Conditions

CONSENT TO UNDERTAKE COUNSELLING

Counselling is an interactive process where you, as the client, have the opportunity to explore issues of concern to you under the guidance of a trained and experienced therapist who assists you in identifying unhelpful patterns and contributing factors, underlying causes, and who works with you to develop helpful strategies and more useful ways of looking at these concerns to alleviate distress and aid in the development of greater emotional and personal well-being.

For further information on how to get the most out of counselling, please visit ronnieadamowicz.com While most clients find counselling immensely beneficial and life-changing, success cannot be guaranteed and largely depends on how open you are, how committed you are to therapy, how hard you are prepared to work and how committed you are to change.

Counselling is a process that leads you to look at life’s challenges and personal issues closely and, as such, can have risks associated with it due to the exposure to, at times, intense and difficult feelings and thoughts being explored.

These risks may include a wide range of strong emotions and thoughts, feeling tired or drained, headaches, nausea, or other physical and emotional symptoms. If you experience any of these symptoms at any time, please let your therapist know. Sessions will be 45-50 minutes long.

The remainder of the hour is used by the counsellor to begin required documentation, background research and treatment planning for their process with you.

For communication between sessions, we only use email communication and text messaging for administrative purposes. 

This also means that email exchanges and text messages with my office should be limited to administrative matters.

This includes things like setting and changing appointments, billing matters, and other related issues.

You should be aware that we cannot guarantee the confidentiality of any information communicated by email or text. Therefore, we will not discuss any clinical information by email or text and ask that you do not either.

Also, we do not regularly check work email or texts, and we do not respond immediately, so these methods should not be used if there is an emergency.

We will try and get back to you within 24 hours (except weekends / holidays).

CONFIDENTIALITY RECORD KEEPING

As part of providing a counselling service to you, your therapist will need to collect and record personal information from you that is relevant to your current situation.

It is important for your therapist to collect this information as it forms a necessary part of the psychological assessment and treatment that is conducted.

What you discuss in your counselling sessions is private and confidential. As such, the therapist requires your written permission to speak to a third party (e.g.: your doctor) about your treatment.

There are only three exceptions to this:

1) if there is a risk of harm to you or to someone else and
2) if a court of law subpoenas documentation.
3) Supervision

While therapists do keep records about your treatment which are securely kept under lock and key with only your therapist having access to this record.

Psychologists and psychotherapists are bound by the Australian Psychological Society’s Code of Ethics, PACFA, ACA and current Privacy Legislation.

Ask us about our Privacy Policy for more information. All of the above exceptions to confidentiality are extremely rare, but it's important for you to be aware of these limitations of confidentiality under exceptional circumstances.

In regards to Supervision, therapists and counsellors may sometimes record sessions and discuss your case with a registered supervisor. This can dramatically help the therapist in working more effectively with you. However, we also understand that some clients may want to opt out of this.

If this is you, please advise your therapist for an alternative consent form.

Risk of Harm

  • Online therapy sessions  is not a crisis based clinical service.
  • Online psychotherapy may not be appropriate for clients with active suicidal or homicidal thoughts, or clients who are experiencing acute mental health problems, such as manic or psychotic symptoms.
  • It is the responsibility of the client to inform their ronnieadamowicz.com therapist if they are at risk of harm to self or others.
  • At intake, a client who reports being at risk of harm to self or others, will not be offered *online* psychotherapy services from ronnieadamowicz.com.
  • If through the intake evaluation or subsequent psychotherapy sessions, a client is deemed to be at risk of harm to self or to others, sessions will need to be in person.
  • If a client who was not formerly at risk, should become at risk of such harm to self or others, they must immediately report it to their ronnieadamowicz.com therapist. In such cases, a client may be referred to a traditional non-online counselling program or provider.

Authority to Debit a Credit Card or Withhold a Deposit

By signing this form you are providing your authority to charge your valid credit card or withhold part or all of your deposit in the event of any cancellation fees being incurred under our cancellation policy.

We will only charge your card or withhold your deposit if you incur a cancellation fee under the terms of the cancellation policy (or, with your prior approval, for any other amount payable).

If you believe your account has been debited incorrectly you should contact us immediately. If we find that your account has been incorrectly debited we will issue a credit card refund accordingly. We will confirm the amount of the refund in writing. If we find your account has not been incorrectly debited we will provide you with reasons and evidence in writing.

CANCELLATION POLICY

A minimum of 24 hour notice is required to cancel or reschedule an appointment. A 50% cancellation fee applies to cancellations of less than 24 hour notice.

Clients are required to make any changes to bookings using the online dashboard https://ronnieadamowicz.com/account

CRISIS MANAGEMENT

Your therapist will develop strategies and a plan with you to assist in the management of a crisis if you are at risk and if this is appropriate as part of your treatment.

However, we are a private counselling practice and, as such, are not equipped to offer crisis services.

In case of an emergency or crisis, please contact triage at your local hospital or Lifeline on Ph: 131 114.

Online Counselling via Zoom or Google Meets Zoom is a secure (encrypted) video conferencing system, and is virtually impossible for anyone to intercept and decrypt the video transmission between two people.

OTHER CHARGES

If needing documents written, please note a $100 fee is charged per page.

ZOOM / ONLINE VIDEO SECURITY

Please see the Zoom / Google Meets security page for more information. However, as with all forms of internet communication, if someone has access to your Zoom / Google Meets login details or has installed a virus on your computer, then it is possible your Zoom / Google Meets transmission can be compromised. Ronnieadamwoicz.com is not responsible or liable for compromised Zoom / Google Meets communication between you and your counsellor.

It is VERY important you keep your Zoom / Google Meets login details secure and private, and routinely check your computer system for viruses and trojans.

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