I understand that The Psych Wellbeing provides counselling and talk-based therapy only. This is a non-medical, non-psychiatric service. No diagnoses will be made and no medications will be prescribed.
Purpose of This Form
The purpose of this form is to document an agreement between the psychologist and the client regarding online psychological counseling. It explains the nature of our services, confidentiality, and exceptions to confidentiality.
I, [Your Name], hereby give my consent to receive online psychological counseling services from The Psych Wellbeing according to the following terms:
1. Purpose of Services
The goal of these sessions is to support my mental well-being, provide psychological guidance, and help me navigate my concerns. I understand that I will actively participate in identifying my needs and session goals.
2. Client's Rights
I have the right to decide what information I wish to share during my sessions.
I understand that online sessions may have limitations, such as internet disruptions or confidentiality risks.
I will ensure I am in a private and secure space during the sessions. If I am dissatisfied with the services, I can discuss my concerns with my psychologist or discontinue services at any time.
3. Confidentiality & Exceptions
My psychologist will keep my information confidential and will not share it without my consent, except in the following situations:
- Supervision & Professional Guidance: My psychologist may seek supervision or professional advice while ensuring my identity remains anonymous.
- Risk of Harm: If I express thoughts of harming myself or others, my psychologist has the ethical duty to take necessary action for safety, including informing relevant authorities or emergency contacts.
4. Technical Limitations & Consent
I understand that online counseling has limitations compared to in-person Sessions, including potential technical issues. I will not record, share, or distribute session content without prior consent from my psychologist.
Confidentiality: I understand that everything I share with my counsellor is kept strictly confidential. The only exceptions are situations where there is a serious safety risk to myself or others, as required by professional ethics.
My information: I consent to the collection and use of the information I have provided in this form for the purpose of counselling and therapy at The Psych Wellbeing. This information will not be shared with anyone outside the practice without my permission.
Voluntary participation: I understand that I am free to end counselling at any time and that I can choose not to answer any question I am not comfortable with.
I confirm that the information I have provided is accurate and complete to the best of my knowledge. I agree to the terms of online counselling and Talk therapy as described above.