Counselling Agreement

Participation in Clearsight's face-to-face or telephone counselling service are establishes your agreement to the following terms and disclaimer.

1. Client Record Details -- I confirm that all information provided by me (the client) regarding my name, gender, age and place of residence is true and correct. If I choose to conceal my true identity from my counsellor, I will tell the counsellor, who may or may not choose to proceed on this basis.

2. Confidentiality -- I understand that Clearsight Counselling will protect my private and confidential information by all reasonable means. Furthermore, that Clearsight Counselling will store and maintain my electronic and hardcopy information in accordance with the Privacy Act. I understand and accept that if, in the mind of the counsellor, there seems to be a real likelihood of harm being done to a client, or harm to others being done by a client, Clearsight Counselling reserves the right to make a report to an appropriate authority.

3. Emergency Situations -- I agree that, if at any time, I feel, think or believe I am in a crisis a situation and require emergency assistance, I will not rely solely on Clearsight Counselling and will seek appropriate assistance elsewhere. (For example, by phoning: Emergency - '000'; Lifeline 24 hour crisis counselling line - 13 11 14; Problem Gambling Help Line - 1800 622 112 or a local doctor/hospital).

4. Referrals -- I accept that Clearsight Counselling counsellors have a duty of care to all clients and that I may be referred to a service other than Clearsight Counselling if the counsellor(s) decide that they are unable to assist me.

5. Legal Jurisdiction -- I understand and accept that the Clearsight Counselling service is governed and bound by the laws of the State of Western Australia.

6. Fees -- I understand and accept that Clearsight Counselling fees are to be paid prior to or at each counselling session. I agree to state the amount of time I require for counselling before the session commences and that the session will conclude at the end of the agreed time. I agree to pay the amount stipulated on the fee schedule for each session. I agree to pay a cancellation/rescheduling fee if I cancel or reschedule an appointment without giving at least 36 hours notice to my counsellor (except in the case of a medical emergency). I accept that fees are not refundable (except under extraordinary circumstances).

7. Termination of Services -- I agree to inform my counsellor if I wish to terminate counselling. I also understand and accept that the counsellor may withdraw services at any time and that in this case a reason(s) will be provided to me.

Disclaimer