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Disclosure

SERVICE AGREEMENT AND CONSENT

IMPORTANT: THIS DOCUMENT CONTAINS INFORMATION ABOUT OUR PROFESSIONAL SERVICES INCLUDING THE
SERVICE OFFERED, PATIENTS’ RIGHTS AND RESPONSIBILITIES AND CONSENT TO SERVICE PROVISION.

Psychotherapy is proven to bring many health benefits to patients. It has proven to lead to better relationships, provide
avenues to solutions to specific problems, and can help to reduce feelings of distress. It is important to understand
that at times these outcomes are achieved by passing through very uncomfortable times in therapy. On many
occasions it is unpleasant to discuss difficult events in life as well as to talk about feelings and emotions. Sometimes
you may be more aware of feelings of sadness, anger, guilt, shame, frustration, loneliness, hopelessness and helplessness
and it is important that these feelings are talked about during sessions in order for psychotherapy to be effective.
Science shows that people benefit from psychotherapy but be mindful that there are no guarantees. In some cases
psychotherapy can be detrimental. However, when the clinical alliance (relationship) between patient and therapist is
strong and the patient is highly motivated then psychotherapy is most effective.

Engaging in psychotherapy will involve your commitment with significant time, money and energy and so it is important
that you feel comfortable in the work you are completing with your therapist. If any questions or concern arise
please bring them up with your therapist as soon as you are aware so that these may be addressed timely and professionally.
All of our therapists hold tertiary qualifications in Psychology and have undertaken due process for competence and
registration as Psychologists according to the national requirements mandated by the Australian Health Practitioners
Regulation Agency (AHPRA). All our therapists are Registered Psychologists regulated in practice underAHPRA and
their registration and status cane verified at any time on the following internet site: www.ahpra.gov.au/registra
tion/registers-of-practitioners.aspx – Also, all of our therapists are members or associate members of the Australian
Psychological Society (www.psychology.org.au) and are registered as providers under the Medicare scheme for
the provision of professional psychological services. Dan Banos is also an international member of the American Psychologist
Association (APA), and member of member of the European Psychiatric Association Section of Suicidology
and Suicide Prevention.

Our services are charged on a med basis. Please make sure to choose carefully from our service options. Once you
purchase a service, this will be provided at a time as selected by you during your online booking. By signing this
agreement you agree that you have read and understood the charges implied for the level of service chosen.
You understand that this agreement includes but may not be limited to cancellation and late attendance fees as stipulated
in the service selection you chose. Please familiarise yourself with this to avoid any future disappointment.

The following charges apply:

• Cancellation/rescheduling with more than 24hrs in advance from the appointment time: Nil penalties apply
• Cancellation/rescheduling with less than 24hrs notice in advance: $70 penalty applies (this must be paid
prior to being served/delivered the already paid service. This fee is applied due to the booking time that
could have been provided to another client but which was place on hold respecting your preferred/chosen
appointment date and time)
• No show without cancelling/rescheduling appointment: Full fee charged

*If you missed your appointment due to special circumstances, this may be considered by the practitioner you booked
with on an individual case by case basis. Any cancellations/changes may be completed by sending an email to:
admin@newstartpsych.com.au

Some of our services may be eligible to a Medicare rebate if a Mental Health Care Plan has been developed and sent
to us by your General Practitioner (GP) and/or send to us by you prior to the day of consultation. The plan must be
current as per Medicare guidelines. It is your responsibility to ensure that you discuss this plan with your GP, including
the amount of sessions left in your plan for Psychologist service provision. If you have specific questions about this
rebate please make your questions known to our friendly staff.

Be mindful that the first few sessions typically involve an evaluation of your needs and the start of a therapeutic rela-
tionship. On the first session a comprehensive assessment will be initiated and typically lasts 60-90 minutes. There-
after most sessions have a 50-60 minutes duration but be mindful that this is a general guide and the duration of any
given session will be based on your needs. It is highly encouraged that a discussion be held with the therapist to find
out the number of sessions that may be required as this may vary depending on the patient needs and circumstances.
You can expect that during the initial states of therapy your therapist will discuss his clinical impressions about the
your case, the expected amount of work, and a relevant plan for treatment. Lastly, ending therapy is also an important
process and so your therapist will also discuss the expectation for the accomplishment of your goals and how these
expectations relate to the process of ending the therapeutic relationship.

The following section provide a non-exhausting list of what you could expect from our service.

Rights and Responsibilities

• I have/my child has the right to receive a competent and professional service
• I have/my child has the right to provide feedback to NEWSTART Psychology & Counselling for services received
• I have the right to know my fee-paying responsibilities and was given a clear statement about the fees including applicable
cancellation fees
• I/my child has the right to be treated with up to date evidence-based models proven by science to be of benefit to
my/my child’s specific concern and that this practice bases its intervention on a cognitive behavioural therapeutic
(CBT) approach, as well as interpersonal psychotherapeutic approaches, and attachment-based interventions.
• I/my child understand that this is a Psychology Practice with a Christian-based framework and principles, and that
prayer and meditation is used in the practice and encouraged with patients as part of the evidence-based model
utilised
• I/my child understand that I will be treated with respect and will respect others in this Psychologist Practice
• I/my child understand I have the right to be clear about the goals that you/your child and the Psychologist are working
toward
• I have received and discussed the number of estimated sessions required to achieve my/my child goals
• I have received a clear explanation of the service I will be rendered
• I understand that my/my child’s records are stored securely in order to maintain my/my child’s privacy
• I understand that while trust and confidentiality are important to the success of psychotherapy, there are some limits
to confidentiality which are established by state law and professional ethics. For example, legal statutes in the
the State of Queensland mandate that confidentiality may need to be broken in certain emergency situations where
there is imminent danger to self and/or others, or where there is abuse of a vulnerable party such as a minor child,
an elderly individual, or persons with serious developmental disabilities or serious mental illness
• I have received an explanation about the nature and limits of confidentiality surrounding the service I/my child will
receive

By accepting this agreement you hereby understand and authorise for NEWSTART Psychology & Counselling staff to
request and/or release relevant information to other agencies involved in my/my child’s treatment plan for the purpose
and duration of my/my child’s treatment.

By accepting this agreement you understand that this consent can be revoked at any time except to the extent that
disclosure in good faith has already occurred in relation to this consent.

By accepting this agreement you have read, understand and accept the policies described in this agreement, including
the annexed fee schedule.

______________________________________________________________________________________________

IMPORTANT: YOUR ACCEPTANCE OF THIS TERMS AND CONDITIONS IS EQUIVALENT TO SIGNING OUR SERVICE
AGREEMENT. BY PURCHASING THE SERVICE YOU HAVE SELECTED YOU AGREE THAT YOU READ THIS AGREEMENT
AND AGREE TO ITS TERMS AND CONDITIONS, AND ALSO ACKNOWLEDGE THAT YOU HAVE UNDERSTOOD ALL MATTERS
INCLUDING THOSE IN RELATION TO FEES.

“Providing a NEWSTART for mind, character and personalities”

ABN 15 684 956 030

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