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CLIENT INFORMATION

CONSENT FOR THERAPY

PLEASE COMPLETE THIS FORM BELOW BEFORE YOUR INITIAL SESSION. PLEASE FAMILIARISE YOURSELF WITH THE TERMS.

In order to provide quality assessment and therapeutic services, AOPCAAT will collect and record personal information relevant to your situation.

Purpose of collecting and holding information Any personal information gathered as part of your assessment and treatment process will be kept securely and, in the interests of your privacy, used only by your therapist at AOPCAAT and any authorised professionals. Your personal information is retained in order to document what happens during sessions.


Access to client information You are entitled to access your personal information kept on file, unless relevant legislation states otherwise. If you require access to your information please discuss this with your therapist.


Disclosure of personal information Personal information gathered by your therapist during the provision of services is considered confidential and will not be disclosed to another party except when your prior approval has been gained or you or another person are at harm, or serious risk. 

Confirmation of Consent (If under 16 please provide parental consent)

have read and understood this Consent Form, and I agree to the above conditions for the services provided by Ashley Ogilvie.

Date of birth
Day
Month
Year
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If you need to reschedule your appointment, AOPCAAT will make every effort to support this based on availability. N.B Any late notice (24hrs) cancellations will be charged at full fee.

0426757107

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