Informed consent form for in-person sessions 
during the COVID-19 pandemic

This document contains information about the nature of in-person services taking into account the COVID-19 pandemic. The practice’s approach is informed by advice from the Department of Health, public health orders and best practice recommendations. In providing face-to-face services, a number of factors must be considered, including vaccination status, risk of exposure and duty of care to protect the individual and public health. There may be other considerations that you may like to discuss with the practice.

Please read this document carefully concerning the risks of opting for in-person services and let the practice know if you have any questions. By consenting “yes” to the Client Agreement form at the end of your online intake form, it is considered an official agreement between yourself (and any other attending parties) and the practice/your psychologist. Alternatively, if you’re a current telehealth client of Peaceful Mind Psychology and your sessions are converting to face-to-face consultation/s, then your attendance at the clinic is taken as consent to this COVID-19 agreement.

Your psychologist has decided to meet in a face-to-face format for at least some of your sessions together. If there is an increase in health risk, including a spike in COVID-19 cases or other pandemic related concerns, your psychologist or the practice may choose to return to sessions via telehealth where appropriate and clinically relevant.

You understand that by returning to in-person services in a shared environment, you are assuming a risk for potential exposure to the virus.

It is important to acknowledge that all parties are responsible for taking relevant precautions to minimize exposure to COVID-19, and keep everyone safe (yourself, your psychologist, other staff, other patients, our families, and our broader community).

To maintain ongoing in person services you:

  • will alert the practice of you vaccination status. If you are not vaccinated or do not wish to disclose your vaccination status we will discuss with you the option of consulting your psychologist via Telehealth in accordance with our practice’s Covid Safe Plan. We require clients attending the clinic to be fully vaccinated and to supply a vaccination certificate. Our psychologists are also fully vaccinated.
  • will alert the practice prior to appointments of any possible symptoms you have experienced, within the 10 days prior to your appointment.
  • will let the practice know before any appointment if you are unwell or have been in contact with a COVID positive case, and
  • we will reschedule your appointment or make it telehealth if possible
  • will sign into the practice rooms using the relevant CovidSafe app and QR code or manually sign in with the required details.

The practice may change the above precautions if additional local, state, or federal orders or guidelines are published. If that happens, our practice will notify you about any necessary changes.

Our practice is operating under a COVIDSafe plan and taking necessary precautions to protect your safety on this premises. If you have any queries about what we are currently doing to ensure we maintain an optimal level of safety, please do not hesitate to discuss these efforts with the practice or your psychologist.

Notably, we are unable to eliminate all risk, therefore if your psychologist, or anyone who enters the premises tests positive for COVID-19, we will notify you according to current government requirements for contact tracing. Additionally, in the case where the clinic has an infection, we may be required to notify local health authorities or government bodies. If this is the case, the practice will only provide the minimum necessary information (in line with QR code check in data) to the relevant authorities. No further details regarding your interactions with your psychologist, and your work together, will be disclosed.