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Client Details & Confidentiality and Therapeutic Agreement

Please find below the intake form for Rise Counselling and Social Work. This form provides you with the opportunity to review, consent to, and agree to the confidentiality and therapeutic agreement before commencing counselling.

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Confidentiality and Therapeutic Agreement

I understand that Rise Counselling and Social Work offers trauma-informed counselling in a safe, confidential space with Tayla. This is not a crisis service. For urgent support, I can contact Lifeline on 13 11 14 or call 000 in an emergency.
Yes
No
I understand that what I share is confidential unless: 1) there’s serious risk of harm to myself or others, 2) a court orders records be shared, or 3) I give permission for Tayla to share information with others to support my care.
Yes
No
I understand that session notes are kept in a secure system and are only accessible to Tayla. I understand I can request access to my file. Records are kept for 7 years after the last session (or until a minor turns 25), as required by law.
Yes
No
I understand that information about me will only be collected and stored when it is relevant and necessary for providing counselling services, and that my privacy will be respected in line with professional, ethical, and legal requirements.
Yes
No
I understand I have the right to be treated with respect in counselling sessions, make choices, ask questions, pause therapy, and give feedback.
Yes
No
I agree to arrive on time, communicate respectfully, and let Tayla at Rise Counselling and Social Work know if something doesn’t feel right during the process.
Yes
No
I understand that sessions run for 60 minutes via telehealth. Payment is usually made before the session, or an invoice will be sent after. Online payment options are available. Please reach out to discuss payment arrangements.
Yes
No
I understand the cancellation policy: a full refund is given with 48+ hours’ notice, a half refund with 24–48 hours’ notice, and that late cancellations may incur a fee or affect my access to future sessions due to high demand.
Yes
No
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