Client Agreement & Informed Consent Form
Welcome
Welcome to Matt Phillips Counselling and Psychotherapy. I offer a professional, confidential counselling service grounded in Process-Oriented Psychology, tailored to your individual experience and pace. This form outlines the key terms of our work together, ensuring mutual understanding and consent.
Therapy Details
Session Length: 1 hour
Format: Online via secure video call (details provided upon booking)
Frequency: As discussed and agreed individually
Fee: $90 per session
Payment: Fee must be paid before the commencement of each session.
Cancellation Policy
Cancellations require at least 48 hours' notice. If you cancel within 48 hours or do not attend your session, the full session fee will apply.
Confidentiality
Your sessions are confidential. This means I will not share what you tell me unless:
- There is a serious risk of harm to yourself or someone else
- I am legally required to disclose information (e.g., court subpoena)
- You give written consent for me to share information with someone else
I attend regular professional supervision where your identity is kept anonymous and your privacy is maintained.
Privacy & Record Keeping
Your information is securely stored in compliance with the Australian Privacy Principles (APPs). Session notes are brief and stored securely; you have the right to access them. Communication is conducted via encrypted platforms where possible. However, online communication carries inherent risks, and by signing this form, you acknowledge and accept those risks.
Online Therapy Acknowledgement
By participating in online therapy, you agree:
- You have a private, quiet space for sessions.
- You are responsible for your internet connection and device.
- You understand that online therapy is not suitable for emergency or crisis situations.
Crisis Plan
If you are in crisis or at risk of harm, please contact:
- Lifeline: 13 11 14
- Emergency services: 000
- Your GP or local hospital emergency department
Client Rights
You have the right to:
- Ask questions at any time
- Withdraw from therapy at any point
- Request access to your personal records
- Make a complaint through the appropriate professional channels
Contact
You can reach me via:
- Email: [Insert email here]
- Phone: 0478 780 046
I aim to respond within 1–2 business days.