New Client Registration
Limits of Confidentiality
I understand that my counsellor is committed to protecting my privacy and the security of my personal data. All consultations will be conducted in a professional manner where privacy and confidentiality are assured. Disclosure of confidential information will only occur:
If I show signs of harming myself or another person(s); or
In compliance with a Court Order; or
If I give my written permission to disclose it with another person or agency.
Limits of Professional Counselling
I understand that Dr Senior assists clients seeking behavioural change or those experiencing personal distress and social and other personal problems through professional counselling using a range of psychotherapy and hypnotherapy modalities and that while he will strive to assist me with behavioural change or personal issues, he will not be held responsible if my personal circumstances remain unchanged.
I understand that counselling fees may vary depending on the nature of the counselling that I receive and are for 50-minute sessions, payable at the time of each session by VISA or MasterCard and that if I fail to attend a scheduled appointment at the agreed time, I will be required to pay for the scheduled session in full.
Medicare, DVA, NDIS and some private health insurers rebates may be available to qualified members – please check with your insurer.
By submitting this form I acknowledge that I am over 16 years of age and have read, understood and agree to the above terms and conditions and that the information that I have provided is true and correct.