Client Consent Form

Client Consent Form

Please select age: *

Under 16 years of age16 years and over

Client First Name: *

Client Surname: *

I, Parent/Legal Guardian name:

have read and understood and accept the Terms and Conditions (https://www.hallpsychology.com.au/terms-and-conditions.html) and give consent to: *

to liaise with the following people involved in my care about my psychological treatment. Please identify the people you consent for us to contact (it is a requirement of Medicare that we provide written reports to your GP):

to liaise with the following people involved in my/his/her care about my/his/her psychological treatment. Please identify the people you consent for us to contact (it is a requirement of Medicare that we provide written reports to your GP):

General Practitioner name

Medical Specialist name

Insurance Company name

Insurance Claims Manager name

Rehabilitation Company

Rehabilitation Coordinator name

Physiotherapist

School Counsellor / Year Coordinator name

Parent / Guardian(s) name

Parent / Guardian(s) number

Emergency Contact name

Emergency Contact number

I understand and accept that personal information gathered by my psychologist will remain confidential and secure except when:

1. Failure to disclose the information would place you or another person at risk of harm,*

2. It is subpoenaed by a court,

3. My prior approval has been obtained to provide either a written report or to discuss the material with an external professional or agency.

*Psychologists are considered “mandatory reporters” and are required by law to report to the statutory regulatory body if they suspect (using their professional judgement and training), on reasonable grounds, that a child or young person is at risk of harm (i.e. physical, sexual or emotional abuse or neglect).

*

Client Consent for Use of AI Technology in Psychological Services

As part of providing high-quality psychological care, your clinician may use artificial intelligence (AI) tools, includingNovoNote, to support aspects of documentation and treatment planning. This document explains how such technologies may be used and seeks your consent.

1. Purpose of AI Use

The AI tools may assist in the following areas:

Transcribing clinical notes or summaries from sessions.
Generating draft reports (e.g., progress notes, letters, assessments).
Supporting treatment planning and formulations.
Organising and summarising information to support clinical decision-making.
Enhancing administrative efficiency to allow more time for clinical care to allow us to focus more on communication and your care during sessions, rather than being distracted by manual note-taking.

2. Confidentiality and Data Security

AI tools used by this practice (such as NovoNote) are selected based on their compliance with relevant privacy and data protection laws, including the Australian Privacy Act 1988 and the APS Code of Ethics.
NovoNote complies with the Australian Privacy Principles and is compliant with AHPRA and HIPAA standards. It adheres to industry encryption and security protocols. NovoNote operates on a secure server in Australia and your data does not contribute to training AI models. For more detailed information on the security measures and protocols of NovoNote, please visit the security page: NovoPsych.com.au/NovoNote_Security
Only your clinician will have access to your information.Your dataprotection is our top priority.
Identifiable information is handled with care. All data shared with AI systems is de-identified or anonymised.
AI tools used in this practice donotmake autonomous clinical decisions. All clinical interpretations, diagnoses, and treatment plans remain the responsibility of your treating psychologist.
As a healthcare provider, we keep notes of our contact with you to help us serve you better. Our AI note taker, NovoNote, helps by transcribing the session and then providing a summary of that session. Typically, the transcript of the session will be deleted and will not make up part of your patient file, while the summary is saved as part of your file.
Conversations are transcribed simultaneously while they happen, meaning no audiorecordings are ever stored.Novonote data is stored on a secure server in Australiato comply with local jurisdiction requirements. Only data will becollectedthat is essential forprovidingservices.Novonote data processors never train AI models using your data.

3. Limits and Safeguards

AI-generated content (e.g., drafts or notes) is always reviewed and edited by your clinician before being added to your file.
No AI tools will be used for surveillance, behavioural prediction, or any purpose outside the scope of your psychological care.
Only data will becollectedthat is essential forprovidingservices.
Notes that a clinician saves at the end of each appointment will be copied and added to your Electronic Health Record in your clinician’s secure Practice Management System, as standard.
You may ask at any time how your data is used and may revoke your consent at any point without affecting your access to psychological services.

4. Voluntary Consent

By signing this form, you acknowledge that:

You have read and understood this information.
You consent to the use of AI tools, including NovoNote, as described above to support your psychological care.

If you have concerns or wish to limit the scope of AI use in your care, please discuss this with your psychologist.

Client Consent for Research

I consent to Hall Psychology and Coaching using and sharing my de-identified and anonymous personal information and questionnaire results for research. I understand that I may withdraw my consent at any time although if my personal information has been used in a project or incorporated in a database it may not be possible to remove my personal information. I consent to Hall Psychology and Coaching using and sharing my personal information to contact me about participating in future research projects.

Client Consent for Marketing

I consent to receiving emails from Hall Psychology and Coaching with information about services, promotions, special offers, news and events.

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