As part of providing a psychological service to you, I (Bronwyn Russo - Clinical Psychologist) will need to collect and record personal information that is relevant to your current situation. This information will be a necessary part of the psychological assessment that is conducted. Information is required to be accurate, complete and as up to date as possible.
Access You may access the material recorded in your file upon request. Copies of reports are available although charges apply.
Confidentiality All personal information gathered during the provision of psychological service will remain confidential and secure except when: 1. It is subpoenaed by a court; or 2. Failure to disclose the information would place you or another person at risk; or 3. Your prior approval has been obtained to: a) provide a written report to another professional or agency e.g. a GP or another professional; or b) discuss the material with another person e.g. a family member
Generally files are kept for a minimum of five years then destroyed.
Cancellation If you need to cancel or postpone your appointment, please give at least 24 hours notice, otherwise you will be charged in full for the missed session.
I , (Print Name In Block Capitals)
have read and understood the above Consent Form.
have read and understood the above Consent Form. I agree to these conditions for the psychological service and I give consent to be seen by Clinical Psychologist, Bronwyn Russo.
Please Note: If, after reading this page you are unsure of what is written, please feel free to discuss it with me.
Bronwyn Russo
Clinical Psychologist
