To ensure the welfare, satisfaction and protection of privacy for all our clients, The GRID Trust (trading as Psychology Café® and Psychology Milk Bar®) and all its employees operate in accordance with the following service agreement and consent terms. If you have any questions about this service agreement, please feel free to discuss these with your attending clinician. 

Service

As part of providing a professional service, your clinician will need to collect and record personal information from you that is relevant to your current situation. This information will be a necessary part of the assessment and therapeutic intervention that is conducted. 

Disclosure to Specific Third Party

Under a Medicare Mental Health Care Plan, it’s a requirement for our service to communicate with referring GPs or Specialists (e.g. provide thank you letters for referrals and update reports). This form of communication (including e-mails, telephone calls, and/or letters) is provided without charge. 

Confidentiality

All personal information collected and recorded by your psychologist is treated as confidential and secure. Apart from service evaluation purposes or communicating with your referring GP or Medical Specialist (providing thank you letters for referrals and update reports) or internal psychologists, we will not disclose any information about you or your family to any other agency or person without your permission unless:

a.    Mandated by a court of law;

b.    We believe you are a threat to the safety or integrity of yourself, or to someone else. In such an unlikely event, every effort will be made to discuss this with you prior to any disclosure;

c.    Your approval is given to communicate with another professional/agency (e.g. GP or lawyer), organisation (e.g. your child’s school) or person (e.g. parent, spouse, employer). 

For service quality, supervision purposes, and to ensure the safety and security of both clients and clinicians, consultations may be recorded via audio and/or video means. Any recording is treated as strictly confidential. Written permission will always be sought prior to the use of such recordings for any other reason, excluding legal proceedings. 

Declaration

I have read, understood, and agree with these terms of service. 

Release from Liability and Waiver All Claims

I hereby release The GRID Trust (Trading as Psychology Café® and Psychology Milk Bar®) and any employee or agent and waive any and all claims I may have regarding any breach of my (or my child’s) privacy or confidentiality which may arise from of having a consultation in a Café or Milk Bar style setting. 

Fees and Compensation being charged to Credit Card

I hereby commit to pay all fees and compensation where required. I irrevocably authorise The GRID Trust (Trading as Psychology Café® and Psychology Milk Bar®) to debit my credit card account with the amount of any fees or charges payable by me under this agreement.

Default Action

I hereby commit to pay all fees as detailed in this agreement. I authorise Psychology Café to debit the credit card account noted with the amount of any fees payable under this agreement. I understand that failure to honour this commitment may result in the cancellation of future appointments and/or referral to a third-party debt collector.

I acknowledge that if any fees or compensation remain outstanding for any reason The GRID Trust may, without prior notice to me, debit my credit card for the due amount at any time without additional notice.  I understand that failure to honour this commitment may result in the cancellation of future appointments, and/or report that fact to the Credit Reference Association of Australia or other default registry, which may affect my credit rating in the future, and/or refer any outstanding fees to a third party debt collector.

I understand that if The GRID Trust makes a report on me to the Credit Reference Association of Australia, I may not be able to obtain finance and credit until I have paid all that is due.