As part of providing a psychological service to you, Elaine Lopis will need to collect and record personal information from you that is relevant to your current situation. This information is a necessary part of the psychological assessment and treatment that is conducted.

Purpose of collecting and holding information
The information is gathered as part of your treatment and is seen only by the psychologist. The information is retained in order to document what happens during sessions, and enables the psychologist to provide a relevant and informed psychological service.

Access to Client Information
At any stage you are entitled to access the information about you kept on file, unless the relevant legislation provides otherwise.

Confidentiality
All personal information gathered by Elaine during the provision of the psychological service will
remain confidential and secure except where:
1. It is subpoenaed by a court, or
2. Failure to disclose the information would place you or another person at serious and
imminent risk; or
3. Your prior approval has been obtained to
a) provide a written report to another professional or agency. eg. a GP or a lawyer; or
b) discuss the material with another person, eg. a parent or employer;
or if disclosure is otherwise required or authorised by law.

Elaine Lopis may wish to discuss aspects of your personal information with a senior colleague for supervision purposes. In this case, your anonymity would be preserved.

Mental Health Care Plan Consent Form
If you are on the Mental Health Care Plan, as part of the service provided to your Psychiatrist and/or GP, Elaine will be sending an update on your progress from time to time.
The information given to your doctor is of a general nature and is in the interests of keeping your doctor informed so as to provide the best possible treatment for you. Care is taken that no information is given that might contravene the confidential relationship of psychologist and client. If at any time information of a specific or confidential nature needs to be conveyed to your doctor, this will be discussed with you and your written permission will need to be given.

Fees
The fee for each session is $230.00. Where there is a referral from a psychiatrist or a general
practitioner who has completed the Mental Health Care Plan, you will receive a rebate of $93.36 through Medicare. If you wish to claim through your own private insurance, the rebates vary.

Cancellation Policy
If for some reason you need to cancel or postpone an appointment, 24 hours notice is required or you may be charged the full fee for the session.

Your rights
Your rights are outlined in the National Privacy Principles from the Privacy Amendment (Private
Sector) Act 2000