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Counselling Consent Form 

During your treatment with me you will be provided with service via Telehealth. The information below is a consent form to enable me to provide services to you in this way.  Please read the information and reply 'I agree' or similar to confirm your consent to receive Telehealth services.
Please read the information below and then to consent toggle the "I consent" button and electronically sign your name in the space provided. 

Consent for Provision of a Telehealth Service

Where appropriate the services you receive may be provided by telephone or videoconferencing. You are responsible for any costs associated with setting up the technology needed so you can access telehealth services. Our practice will be responsible for the cost of the call to you and the cost associated with the platform used to conduct telehealth services.  

To access telehealth consultations you will need access to a quiet, private space; and the appropriate device, i.e. smartphone, laptop, iPad, computer, with a camera, microphone and speakers; and a reliable internet connection. The privacy of any form of communication via the internet is potentially vulnerable and limited by the security of the technology used. To support the security of your personal information this practice uses Power Diary which is compliant with the Australian standards for online security and encryption. 

 Limitations of Telehealth

A telehealth consultation may be subject to limitations such as an unstable network connection which may affect the quality of the session provided. In addition, there may be some services, clients e.g. children or conditions for which telehealth is not appropriate or effective. Your practitioner will consider and discuss with you the appropriateness of ongoing telehealth sessions. 

About Counselling & Cognitive Behaviour Therapy

You will be provided with evidence based service.

The focus of my practice is holistic and recovery focussed, treatment is a process of empowerment built on my respect for you and your lived experience.  You are the expert on you and the life you have lived and the life you want to live.  I have nearly 40 years experience of aiding people to become fully who they want to be, to heal where possible and to embrace all that they are. My expertise and experience is at your disposal. 

The issues you choose to address will have a major behavioural and attitudinal component. You will be asked to undertake activities to help you to think differently about what is happening to you.


Success is entirely the result of you undertaking this 'homework.' Counselling also requires your willingness to try new things and to persist with different ways of doing things, and yes, to take some risks. This is your choice entirely. Consequently, there are no guarantees of success. 

Change is always hard work. I do not give advice and I make recommendations only, but, I am there to walk with you on this journey. 


You are free to accept or reject any and all recommendations as you see fit. This is a partnership of equals, partners in a shared journey. A journey of healing.

Therapy Session
This is a partnership of equals, partners in a shared journey. A journey of healing. 
                   Tim Sanderson, Psychologist
                                                   Privacy and ConfidentIality

I agree to hold confidential all information that you provide, and to release it to persons outside my practice only when authorised by law and subject to any conditions set by such regulation and by subpoena

I undertake to:

  1. Access information I hold only when necessary for the performance of psychological practice;

  2. Make copies of confidential information only when necessary to the performance of my professional duties;

  3. Oversee the storage and handling of your restricted information to minimise the risk of its diversion into unauthorised channels;

  4. Take reasonable care to properly secure your confidential information on my computer and I will take steps to ensure that others cannot view or access such information;

  5. Not disclose my personal password(s) to anyone  or record or post it in an accessible location.

                                                                 FEES - 2023

*FEES Increases from 01/10/2023

Bulk billing is unfortunately not available.  


DVA card (white or Gold) - no additional fee payable. 

All clients the fee is  $166 ( $92.90 reimbursed by Medicare with a GP MHP for a counselling assessment )

A written report is $166  + GST.  there is no reimbursement from medicare for this.

From October 1, 2023 fees will  payable upfront at the time of booking. 

Invoices will be provided after sessions have taken place and reports have been written. 


Paid receipts will be available for those with Private Health cover with extras, please let us know the details of our Private Health provider.

The default cancellation/No show fee remains equivalent to your session fee rate  within 72 hours of the scheduled appointment for any reason. 


The practice will not be held responsible for medicare decisions relating to your GP MHP

I agree to receiving telehealth services, I have read & understand the information on Cognitive Behaviour Therapy, Fees, privacy and confidentiality. 

Thank you!

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