top of page

Client Consent Form

Nature of Services

I understand that I am engaging in psychotherapy services that may include, but are not limited to:

  • Talk-based psychotherapy

  • Emotional processing and self-exploration

  • Psychoeducation

  • NLP-based techniques and interventions

  • Support for personal growth, self-understanding, and behavioural change

I understand that psychotherapy is a collaborative process and that outcomes cannot be guaranteed.

Scope and Limitations of Practice

I acknowledge and understand that:

  • My practitioner holds an undergraduate degree in psychoanalysis and NLP certification.

  • My practitioner is not a registered psychologist or psychiatrist and does not provide medical diagnosis, psychiatric assessment, or medication management.

  • Services provided are non-medical and non-clinical in nature and are not a substitute for psychiatric care, crisis services, or medical treatment.

If at any time my needs fall outside the practitioner’s scope of practice, I understand that appropriate referrals may be suggested.

Mental Health and Crisis Support

I understand that psychotherapy is not suitable for acute crisis situations.If I experience thoughts of self-harm, harm to others, or am in immediate distress, I understand that I should contact:

  • Emergency services (000 in Australia), or

  • A local crisis support service (e.g., Lifeline 13 11 14)

Confidentiality

I understand that my information will be kept confidential except in the following circumstances:

  • If there is a risk of serious harm to myself or others

  • If disclosure is required by law

  • If required for professional supervision (with identifying details removed wherever possible)

Client Responsibility

I understand that:

  • I am responsible for my own choices, actions, and wellbeing.

  • Psychotherapy involves emotional work that may be challenging or uncomfortable at times.

  • I am free to pause, question, or discontinue therapy at any time.

Consent to Participate

I confirm that:

  • I have read and understood this consent form

  • I have had the opportunity to ask questions

  • I consent to participate voluntarily in psychotherapy services provided by the above practitioner

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

2/227 Koroit Street, Warrnambool

 

bottom of page