THERAPY INFORMED CONSENT AND AGREEMENT
Online Therapy
Welcome! This document contains important information about my professional services and practice policies. Please read through this form carefully and make note of any questions or concerns that you might have so that we can discuss them. When you sign this document, it will constitute an agreement between us.
I work exclusively online providing Teletherapy through platforms such as Zoom. Although Zoom is well encrypted, confidentiality on online platforms is not guaranteed. I will ensure that the therapy session takes place in a confidential space with good connectivity and ask that you do the same. To enable the smooth running of the session, I recommend that the device you are using rests on a stable surface and shows your face clearly. If connectivity is continuously disrupted during a session, we may have to consider alternative platforms such as WhatsApp video call. Please note that recording of any session is not permitted.
It is important to note that online therapy is not for everyone – if at any time you decide that you would prefer to work with a therapist in person, please inform me and I will send you a list of recommended psychologists who are based in your area. Online therapy is not suited to someone in crisis, with self-harm/suicidal risk or in need of risk management (e.g. inpatient admissions). If at any time I feel that online therapy is not clinically adequate, I will need to refer you to a trusted colleague who can see you face to face.
Benefits and Risks
Therapy has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness. This is part of the process of therapy and we will manage this together.
However, therapy has been shown to have benefits for individuals and families. Therapy often leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems. There are however no guarantees with regard to the outcome of psychotherapy.
At the end of our first session, we will discuss our treatment goals. You should then evaluate whether you feel comfortable working with me. Typically, therapy requires a significant commitment of time, money and energy and requires active effort on your part so you should give serious thought to taking on this process.
Appointments
Online appointments are 50-55 minutes in duration, at a typical frequency of once per week, or as agreed upon between the therapist and client. The time booked for your appointment is scheduled to you alone. You are responsible for logging on at the scheduled time. If you are running late for your appointment, please inform me. Please note that your appointment will still end at the scheduled time and you will be charged for the full appointment time. Should you fail to inform me of late attendance, I will wait for 15 minutes, whereafter I will consider the appointment as a missed session.
Cancellation of Appointments
If you need to cancel or reschedule a session, I ask that you provide me with (at least) 24 hours’ notice. I require this time to contact clients on my waiting list in order to fill the time of the cancelled appointment. If you miss a session without cancelling, or cancel with less than 24 hours’ notice, my policy is that you will still be responsible for the full payment. Missed or late cancelled appointments will be invoiced as such, and your medical aid (if applicable) will not pay for the missed appointment.
Fees and Non-Payment of Fees
My fees are R1200.00 for a 50–55-minute session. Fees are payable by EFT on the day of your session. Please send me an e-mail or SMS the proof of payment to me. Banking details: ABSA Bank, Stephanie Oosthuizen Psychologist, account number: 4106345689, branch code: 632005
Please note that I do not submit invoices to medical aid on your behalf and I do not accept payment directly from medical aid. I will e-mail you a statement at the end of your session, which can then be sent by you to medical aid for reimbursement. Please note that it is my right to employ a debt collector if you do not make payment for the professional services provided by me to you. You will be responsible for additional costs accumulated in the process of debt collection.
Medical Aid
Medical aids will generally only cover a certain number of sessions for the year. It is advisable to contact your medical aid to ascertain how many sessions your medical aid will reimburse. Some medical aids have extended benefits. This service must be applied for and once approved, the medical aid will continue to reimburse you. By signing this agreement, you agree that I can provide diagnostic and service related information to your medical aid. You have the right to not submit my invoices to your medical aid for reimbursement.
Contacting Me
I am available from Monday to Friday from 8am-5pm. If I do not answer a call, reply to a text message or e-mail immediately it is likely that I am working with clients. If you leave a detailed message I will get back to you as soon as I am able to. I am unavailable on weekends and public holidays. If you feel you cannot wait for a return call from me or for your next appointment, or if you feel you are unable to keep yourself safe, please go to your nearest Hospital Emergency Room.
Limits of Confidentiality
All information shared with me is confidential and no information will be released without your consent. During the course of therapy it may be necessary for me to communicate with other health care professionals. Consent to release information is given through written authorisation. There are specific and limited exceptions to this confidentiality which include the following:
1.When there is a risk of imminent danger to you or to another person, I am ethically bound to take necessary steps to prevent such danger.
2. When there is suspicion that a child or elder is being sexually or physically abused or is at risk of such abuse, I am legally required to take steps to protect the child, and to inform the proper authorities.
3. When a valid court order is issued requesting medical records, I am bound by law to comply with such requests.
I am under no obligation to write up written reports of any nature relating to any service offered. I do not provide psycho-legal or forensic services.
