As part of providing psychological services to you, Bodycare Health and Wellbeing will need to collect and record personal information from you that is relevant to your health. This information is a necessary part of the psychological assessment and treatment.

PURPOSE OF COLLECTING AND HOLDING INFORMATION

The information is gathered as part of the assessment, diagnosis and treatment and is seen only by the treating psychologist. The information is retained in accordance with the Federal Privacy Act 1988 and kept for a minimum of 7 years as per legislative requirements.

ACCESS TO CLIENT INFORMATION

You are entitled to access the information in your file under the Federal Privacy Act 1988. A formal request in writing must be made in order to receive any case notes.

CONFIDENTIALITY

All personal information gathered by your psychologist during the provision of the psychological service will remain confidential and secure and will not be shared with your employer, except where:

1. It is subpoenaed by a court, or
2. Failure to disclose the information would place you or someone else at serious and imminent risk, or
3. Disclosure is otherwise required or authorised by law.

PATIENT ACKNOWEDGMENT

By signing this consent form, you acknowledge that:

1. participation in this consultation is voluntary;
2. any personally identifiable health information obtained in conjunction with this consultation will be protected and will only be used in accordance with this agreement and applicable laws pertaining to the use of personal health information;
3. any health information obtained, may be used to compile a deidentified aggregate report for my company/employer;
4. all aspects of this consultation will remain confidential;
5. your employer will not be notified of your participation and your individually identifiable health information will not be shared with your employer;
6. the data derived from the consultation is considered to be preliminary and for screening assessments only and will not constitute a diagnosis;
7. the responsibility for initiating a follow-up examination to confirm the results of this screening and obtain professional medical assistance is yours alone and not that of your employer or any organisation associated with these consultations.

I have read and understood the above consent form. I agree to these conditions for the psychological service provided by Bodycare Health and Wellbeing.