Psychological Assessment/Treatment Client Registration, Consent and Service Agreement
Client Responsibilities:
1. Clients must be compliant in attending all scheduled appointments and sessions. Failure to do so will result in a “did not attend” (DNA). This can lead to non-compliance or loss of funding.
2. Clients must give 24 hours’ notice if they are unable to attend scheduled appointments and sessions. Failure to do so will result in a “did not attend” (DNA). When a client fails to attend an appointment we are legally obliged to notify the referrer immediately. This can lead to non compliance. This excludes emergency situations. If a client is self-funded or available funding is exceeded, a charge of 50% of the hourly agreed rate will be charged to the client for DNA.
3. Clients are responsible for their own rehabilitation. We are here to assist you to learn new coping
strategies only.
4. Clients need to attempt all homework tasks asked of them, and practice new strategies at home between appointments. Clients need to use coping strategies on a regular basis to achieve maximum benefit from the strategies.
6. Clients need to be compliant in taking any prescribed medication.
7. From time to time we need to send reports to the referrer and liaise with other health professionals involved in your care, in order to provide an ethically sound therapeutic intervention. These will generally be discussed with you, but we reserve the right to make professional assessments of the situation and to report on these. With your consent, information may be shared with other professionals involved in your care (e.g. GP).
8. Confidentiality does not apply if your life or another person’s life may be threatened by your actions or it is felt further action is urgently required.
Client’s declaration:
I have read (or had read to me), and understand to the above information as set out above. I consent to participate in the proposed program and adhere to the above conditions.
YOUR RIGHTS WHEN RECEIVING A HEALTH OR DISABILITY SERVICE
The Code of Rights gives you 10 rights. These are:
1. To be treated with respect.
2. To be treated fairly without pressure or discrimination.
3. The right to dignity and independence.
4. To receive a quality service and to be treated with care and skill.
5. To be given information that you can understand in a way that helps you communicate with the person providing the service.
6. To be given the information you need to know about your health or disability; the service being provided and the names and roles of the staff; as well as information about any tests and procedures you need and any test results. In New Zealand, people are encouraged to ask questions and to ask for more information to help them understand what is going on.
7. To make your own decision about your care, and to change your mind.
8. To have a support person with you at most times.
9. To have all these rights apply if you are asked to take part in a research study or teaching session for training staff.
10. The right to complain and have your complaint taken seriously.
What can I do if I am worried or unhappy about the service, or something goes wrong, and I feel my rights have been breached?
• talk to the person you received the service from
• get help and support from family and friends to raise your concerns with the provider of the service
• seek the support of a free independent advocate to help you resolve your concerns. Details about how to contact a health and disability advocate are contained in Health and Disability website.
Your Responsibilities
You must notify your lead clinician at least 24 hours in advance of any missed appointment. If you fail to do so you may be charged a fee for the missed session.
Phone: 027 216 2096
Email: office@riverpsychology.co.nz
PO Box 14153, Five Cross Roads, Hamilton 3252
