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Informed Consent for Psychological Services


Nature and purpose of the Psychological Service

As part of providing a psychological service including assessments and counselling to you, Maria Dhroso will need to collect and record personal information pertaining to you and your child. This information is a necessary part of the psychological assessment and treatment that is conducted.

Therapy and counselling vary depending on the personalities of the psychologist and patient, and the particular issues you bring forward. There are many different methods Maria may use to deal with the problems that you hope to address. Therapy and counselling calls for a very active effort on your part. In order for the therapy to be most successful, you and or/ your child will have to work on things we talk about both during our sessions and at home. 

Our first few sessions will involve an evaluation of your/ your child’s needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow. If you have questions about my procedures, we should discuss them whenever they arise. You are able to cease therapy with myself at any time. If you feel uncomfortable with what is happening in a session you may request for the session to cease at any time.

Access to your information 

As part of providing psychological services, relevant personal information to the current situation will be collected and recorded. The information will assist in providing an appropriate and thorough service. Information will be stored in a secure location. I am required to keep your file for a minimum of 7 years, or if you are under the age of 18 at the time of treatment, until you are 25 years of age. You may access the information in your file on request, subject to the exceptions in the National Privacy Principles. 

Confidentiality and Privacy (For further information please see Privacy Policy for the Management of Personal Information) 

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

  1. it is subpoenaed by a court, or disclosure is required or authorised by law; or

  2. failure to disclose the information would place you or another person at risk of harm; or

  3. given your prior approval, or consent of a parent or guardian who is legally authorised to act on a child's behalf in order to provide a written report to another professional or agency, or discuss information with another person e.g., parent or employer; or

  4. you would reasonably expect your personal information to be disclosed to another professional or agency and disclosure is directly related to the primary purpose for which it was collected such as to inform your GP of treatment and progress; or

  5. clinical consultation with another professional is required to provide better clinical services (identifying details will remain confidential). 

If during the course of your work with the Maria Dhroso, she becomes aware of risk to someone’s life, health, or wellbeing, she is required by policy of the state and federal governments to report the matter to the appropriate agencies. 

Session Fees (2023 Session Fees) 

My agreed fee is $ 215.00 per session (up to 50 minute duration) and is payable at the time of consultation.

My agreed fee is $240.00 per session (up to 75 minute duration) and is payable at the time of consultation.   

Private Health Insurance 

Some health insurance policies cover counselling depending on the policy. Please check with your insurance company as to what cover you are eligible and advise us if a particular Item number needs to be billed. 

Medicare Rebates 

Under the Medicare Benefits Schedule (Better Access), Medicare rebates are available to clients with an assessed mental disorder. Medicare rebates are accessed with a Mental Health Treatment Plan and referral from a medical practitioner, psychiatrist, or paediatrician. The rebate is limited to 10 sessions per calendar year and only available with a valid referral. Please note the maximum number of sessions per referral is 6 initially and then 4, rebates will not be given beyond the number stated on the referral. 

Covid additional sessions: Until Dec 2022 an additional 10 sessions per calendar year can be accessed after you have used your initial 10 sessions.  The additional sessions may be referred by your GP in a block of 10.

Parent-only sessions are not eligible for a Medicare rebate.  These are charged at the regualr fee with no rebate.  


In case of emergency, please go to the emergency department of the nearest hospital. For further information refer to the website for your local health district. For out of hours phone support, you may find it helpful to call Lifeline on 13 11 14.


This document describes the privacy policy of My Vibe Psychology for the management of clients’ personal information. The psychological service provided is bound by the legal requirements of the Australian Privacy Principles set out in the Privacy Act 1988 (Cth). 

Client information 

Client files are held in:

an encrypted, cloud-based storage in online booking system with medical grade security which is only accessible to Maria Dhroso. The information on each file includes personal information such as name, address, contact phone numbers, medical history, and other personal information collected as part of providing the psychological service. Personal information will also be collected and held in a secure internet-based appointment scheduling program. 

How clients' personal information is collected 

A client's personal information is collected in a number of ways during psychological consultation. These include times when the client provides information directly to Maria Dhroso using hardcopy forms, correspondence via email, when the client interacts directly with employees of My Vibe such as the receptionist, and when other health practitioners provide personal information to Maria Dhroso, via referrals, correspondence and medical reports. 

Consequence of not providing personal information

If a client does not wish for their personal information to be collected in a way anticipated by this Privacy Policy, Maria Dhroso may not be in a position to provide the psychological service to the client. 

Purpose of holding personal information 

A client’s personal information is gathered and used for the purpose of providing psychological services, which includes assessing, diagnosing and treating a client’s presenting issue. The personal information is retained in order to document what happens during sessions and enables the psychologist to provide a relevant and informed psychological service. 

Disclosure of personal information 

All personal information gathered during the provision of services will remain confidential except when: 

  1. it is subpoenaed by a court, or disclosure is otherwise required or authorised by law; or

  2. failure to disclose the information would in the reasonable belief of Maria Dhroso place a client or another person at serious risk to life, health or safety; or

  3. the client’s, or consent of a parent or guardian who is legally authorised to act on their behalf, prior approval has been obtained to:

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

b) discuss the material with another person, e.g. a parent, employer, health provider, or third-party funder; or c) clinical consultation with another professional is required to provide better clinical services (identifying details will remain confidential); or

d) disclose the information in another way; or

e) disclose 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. 

A client's personal information is not disclosed to overseas recipients unless the client consents or such disclosure is otherwise required by law. Clients' personal information will not be used, sold, rented or disclosed for any other purpose. 

In the event that unauthorised access, disclosure, or loss of a client’s personal information occurs the psychologist will activate a data breach plan and use all reasonable endeavours to minimise any risk of consequential serious harm. 

Requests for access and correction to client information 

At any stage a client may request to see and correct the personal information about them kept on file. The psychologist may discuss the contents with them and/or give them a copy, subject to the exceptions in the Privacy Act 1988 (Cth). If satisfied that personal information is inaccurate, out of date or incomplete, reasonable steps will be taken in the circumstances to ensure that this information is corrected. All requests by clients for access to or correction of personal information held about them should be lodged with Maria Dhroso. These requests will be responded to in writing within 21 days, and an appointment will be made if necessary for clarification purposes. 


If clients have a concern about the management of their personal information, they may inform Maria Dhroso.  Upon request they can obtain a copy of the Australian Privacy Principles, which describe their rights and how their personal information should be handled. Ultimately, if clients wish to lodge a formal complaint about the use of, disclosure of, or access to, their personal information, they may do so with the Office of the Australian Information Commissioner by phone on 1300 363 992, online at or by post to:

Office of the Australian Information Commissioner, GPO Box 5218, Sydney, NSW 2001. 

(3)     Consent for Email and Electronic Communication

This practice offers clients/guardians the opportunity to communicate by email, online SMS, through Halaxy or via telephone or Coviu for the purposes of telehealth.  This form provides information about the risks of electronic communication, how we will protect your information and your responsibilities regarding email communication. This practice will also use this form to document your consent to communicate with you by electronic communication.

Electronic communication is not appropriate for urgent or emergency situations, nor is it a substitute for consultations.

Any written electronic communication of a clinical nature between you and the practice will be added your client file. As emails and other electronic communication are a part of a client file, other individuals authorised to access the file will have access to those emails.

Communication by email and other electronic means has several risks, including, but not limited to, the following:

  • This practice cannot guarantee that an electronic communication will be read or responded to. For example, security software can filter emails before it reaches us and the intended recipient may go on personal leave unexpectedly. 

  • Electronic communication can be circulated, forwarded, and stored in paper and electronic files.

  • Backup copies of the email may exist even after the sender or recipient has deleted their copy.

  • Senders can easily misaddress an email, or unintended recipients can receive an email.

  • Email can be intercepted, altered, forwarded, or used without authorisation or detection.

  • Employers and online services have a right to archive and inspect emails and other electronic communications transmitted through their systems.

  • Administration staff may also receive your emails before forwarding them to your health care provider.

  • The practice will use reasonable means to protect the security and confidentiality of electronic communication information sent and received. However, because of the risks outlined above, we cannot guarantee the security and privacy of email or other electronic communication, and we will not be liable for the inadvertent disclosure of confidential information.

  • We will encrypt any documents we need to send you and forward the password to access this file by another communication method (phone or text message).

  • We will verify your email prior to sending any confidential information.

  • Halaxy:  Information is both in a stored in a secure paper file and on an online practice management system, Halaxy.  Signing this indicates acceptance of Halaxy’s privacy statement   Halaxy complies with privacy regulations.

  • Coviu: The psychologist will use an appropriate and secure online service to deliver treatment.  We use Coviu, which complies with privacy regulations.  Coviu’s privacy policy can be found at  I also agree to the privacy policy of any other platform being used in the event of switching to another provider.

How we will protect your information

o    Put any identifying information in the body of the email, not in the subject line.

o    Include the general topic of the message in the email's subject line, for example, 'advice' or 'appointment'.

Client responsibilities around the use of email

  • I will inform the health care professional of email address changes.

  • When emailing a health care professional, I will:

o    not put identifying information in the email's subject line but will put this in the body of the email.

o    Include the general topic of the message in the email's subject line, for example, 'advice' or 'appointment'.

  • I will contact the health care professional's office via alternative communication methods, such as a different email or fax, if a reply is not received within a reasonable period of time.

  • I will not use email for communicating urgent or emergency information.

  • I will not use email for communication regarding sensitive medical information.

  • I am responsible for informing the health care professional of any information that I do not want to be sent by email.

  • I am responsible for protecting my password or other means of access to email. The health care professional is not liable for breaches of confidentiality caused by me or any third party.

Note – you may withdraw your agreement at any time without any effect on service provision.



Your card that is on file, is charged a 50% cancelation fee of $107.50 when you do not attend an appointment without providing 2 working days of notice.  For sessions booked on a Tuesday this means that you must email no later than Friday by the time of your child’s session time.  This allows us the best chance to fill your child’s appointment time. 

Your child’s appointment time has been set aside for your child.  In addition, planning and preparation for the session has also occurred.  Applying this fee allows My Vibe to provide all our families a sustainable service. 

Medicare rebates do not apply to cancelled/ missed appointment fees.

If your child is unwell, we appreciate you keeping them at home and the session will be conducted via telehealth.  Please note that many clinicians charge a full fee for cancelled/ missed appointments without sufficient notice. 

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