IFS Informed EMDR Group - 2 hours

Cancellation Policy

Consent Form Collection and Holding of Personal Information for Supervision. As part of providing a professional supervision service to you, I will collect and record personal information about yourself or your client that is relevant to your current caseload. This information will be kept on a password protected Google drive. You are legally entitled to have access to the information about you kept on file. If you would like to access this information, let me know and I will arrange a time to show it to you and explain any exemptions. Confidentiality and its Limits All personal information gathered during the provision of service will remain confidential and secure, except in the following circumstances: If your file is subpoenaed by a court, or If failure to disclose the information would place you or another person at serious and imminent risk, or Your prior approval has been obtained to: provide a written report to another professional or agency. eg. (GP or lawyer) or discuss the material with another person, eg. a parent or employer; or 4. If disclosure is otherwise required or authorised by law (e.g. reporting criminal activity). It is a requirement of registration with AHPRA that all registered Psychologists receive supervision from another registered Psychologist. From time to time treatment plans and progress of some current clients are discussed in order to ensure professional standards are met and that clients continually receive quality treatment. In these discussions, all identifying information is deleted or changed. Fees Group consultation 120 minutes in length, $100 per hour plus GST = $200 +$20 = $220 Debiting your Account You may pay directly by direct deposit to our bank account. Integrated Wellbeing Collective Pty Ltd BSB 032 105 A/C 007758 PayPal or Stripe payments available when booking on emdrtherapyenlighten.com.au By signing this form, you agree to pay directly or authorise us to arrange for funds to be debited directly from your Credit Card using Stripe or PayPal. It is your responsibility to ensure that there are sufficient clear funds or credit available in your account to allow a debit payment to be made prior to the time of your appointment. Please feel free to discuss any of the above information with Allie or Jacqueline and please ask for clarification of any aspects of this form that you are unsure of before signing the agreement below. I/we, have read and understood the above Consent Form

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