Consent Form

Consent Agreement for Counselling Services with Jake Forrest

Some Important Facts about Psychotherapy

Professional psychotherapy is a safe and confidential collaboration between a qualified counsellor and you. It provides a space and opportunity for you to explore behaviours, relationships, feelings, or thoughts that trouble you and cause difficulty in your life.

We may seek therapy for a wide variety of reasons. I look forward to exploring your reasons for making your appointment with me and navigating the counselling journey together. What you choose to discuss and explore in counselling is all up to you. You are in control of the topics we explore. The therapist’s job is to truly understand your struggles and goals so that they can help you fully utilise your existing strengths and find your own solutions.

We are all unique with our own history, perceptions, and expectations, and as a result, the outcomes of counselling can vary widely. This means that, as your counsellor, I cannot promise any particular outcome from the therapy process, but I can assure you that I am committed to best practices and adapting my approach in a way that honours your individuality.

Risks in Therapy

Psychotherapy sometimes requires that you be willing to examine difficult topics or times in your life that may evoke stronger-than-usual emotions. Therefore, it is important to keep me informed of any experiences or feelings triggered during the process so that I can support you effectively.

Concluding Services

You are free to end our sessions at any time and for any reason. While no notice is required, I kindly ask that you follow the cancellation policy below. I encourage you to discuss with me if you are considering concluding therapy so we can bring our work to a meaningful close, acknowledging the progress we've made together and helping you carry the benefits forward into your life.

My Professional Background and Counselling Approach

I hold a master’s degree in psychotherapy and counselling and am a Registered Counsellor with the Psychotherapy and Counselling Federation of Australia (PACFA), listed on the Australian Register of Counsellors and Psychotherapists (ARCAP).

Privacy and Confidentiality

Personal Information

I am committed to protecting your personal information in accordance with the Australian Privacy Principles in the Privacy Act 1988 (Cth). Personal information includes any details that can identify you, such as your name, contact information, and any other data you provide during the counselling process. This information is collected to ensure I can provide the best possible care and is stored securely.

Confidentiality

Your privacy is a priority. All information shared during our sessions remains confidential. I will not disclose anything discussed in our sessions to anyone without your written consent. This allows us to create a safe space where you can speak freely and feel supported.

Limits to Confidentiality

There are a few specific circumstances where confidentiality may be legally breached:

If I believe there is a serious and imminent threat to your life, health, or the safety of another person.
If I am legally required to report instances of abuse or neglect involving a person under 18.
If I am ordered by a court to release records or provide information.

In these rare cases, I will take reasonable steps to inform you before disclosing any information, where possible.

My Supervision

I have an ethical responsibility to reflect on my practice and may discuss my work with my clinical supervisor, ensuring all content is de-identified and your identity is kept anonymous.

Some Practicalities

Hours of Practice:

My consulting hours are:

Thursday - 9:00 am to 7:00 pm

Fridays - 9:00 am to 7:00 pm
Saturdays - 9:00 am to 12:00 pm

Session Bookings:

A typical session lasts 50 minutes. I recommend an initial commitment of five appointments, either weekly or fortnightly, depending on your needs. Before your first session, I require new clients to complete a free 15-minute consultation phone call to briefly introduce myself and ensure my services are a good fit for you. After this, you may book appointments directly from my booking page.

Scheduled Sessions:

Sessions are available via telehealth. For each session, both parties must:

Ensure confidentiality and an uninterrupted space. An uninterrupted space means being in a private, quiet location or room where you won’t be disturbed by others or external distractions for the duration of the session.
Not record sessions without each other’s consent.
Ensure a reliable phone or internet connection.
Inform me in advance if you would like another person to attend the session with you, so we can discuss and agree upon their participation.

If these requirements are not met, I reserve the right to cancel or reschedule the session to ensure the quality and confidentiality of our work together. Additionally, if sessions are repeatedly missed without notice, and you fail to respond to my contact, I may conclude your services.

Appointment Reminders

To help you stay on track with your sessions, I use email to remind clients about upcoming appointments. These reminders are designed to support you in managing your schedule effectively. If you prefer not to receive these reminders or wish to opt out, simply let me know, and I will respect your preference.

Therapy in Motion

By agreeing to participate in Therapy in Motion, you understand and consent to the following:

Nature of Sessions
Therapy in Motion involves engaging in a therapeutic conversation while in an outdoor environment, such as local parks, nature reserves, or other suitable public spaces. The session may involve movement, which could include walking or other activities that promote a dynamic environment.

Confidentiality

While I will do my best to maintain confidentiality during Therapy in Motion sessions, please be aware that these sessions will take place in public outdoor spaces where we may encounter others, including people you know. Before each session, I will check in with you to discuss what you would like to do if we come across someone you know. We can decide together whether to adjust the route, take a different path, or continue as planned. Your comfort and privacy are important, and we can always make adjustments as needed.

Safety

Your safety is a priority during Therapy in Motion sessions. Please wear appropriate footwear and clothing suitable for the activity, and let me know if you have any health conditions or physical limitations that may affect your ability to participate comfortably. If at any point you feel unsafe or uncomfortable, you are welcome to stop the session and discuss your concerns with me.

Session Location

The location for Therapy in Motion sessions will be discussed and agreed upon before each session. If the weather conditions or other circumstances are not suitable for outdoor activity, the session may be conducted online instead. If you are booking Therapy in Motion and we haven't already agreed upon a location, please get in contact with me as soon as possible to organise this. If I have not received a response with a chosen location at least 2 days before the session, I reserve the right to reschedule the appointment.

Consent for Movement

Therapy in Motion sessions involve engaging in physical activity. By participating, you acknowledge that movement will be involved, and you should let me know if there are any physical considerations or limitations that may affect your ability to comfortably participate in this format. If movement is not suitable for you, we can explore alternative options to ensure you still receive the support you need.

Session Duration

Therapy in Motion sessions are generally 50 minutes in length, similar to my online sessions. However, the actual duration may vary slightly depending on the location and pace of the activity.

Fees

The hourly charge for individual counselling sessions is $120. Payment is due at the time of booking online. Please discuss if an alternative payment option is needed.

I reserve the right to increase my hourly charge at any time and will communicate this information to you at least 2 weeks in advance of any changes.

Cancellation Policy

I understand that life can be unpredictable, and there may be times when you need to cancel or reschedule your appointment. To ensure fairness and allow others to access appointment times, I have the following cancellation policy:

Notice Period
If you need to cancel or reschedule, please provide at least 48 hours’ notice before your scheduled session.

Fees for Late Cancellations
Cancellations made less than 48 hours before your session will incur a fee equivalent to 50% of the session cost.

Cancellations made on the day of the session or no-shows will be charged the full session fee.

Exceptions
I understand that emergencies and unforeseen circumstances can arise. In such cases, please let me know as soon as possible, and I’ll consider waiving the fee on a case-by-case basis.

How to Cancel or Reschedule
You can cancel or reschedule your session by contacting me via email or phone.
This policy is in place to respect both my time and other clients who may be waiting for an appointment. Thank you for your understanding and cooperation.

Disclaimer

Please note that psychotherapy is not a substitute for medical advice, diagnosis, or treatment. If you have urgent mental health or medical concerns, I encourage you to consult a medical professional. In case of an emergency, please contact 000 or your nearest emergency service.

In an Emergency

As I do not provide a crisis service, please contact these services in case of an emergency:

Your doctor or the emergency department (000)
Lifeline (13 11 14)
Mental Health Triage Service (13 14 65)
Beyond Blue (1300 22 4636)

Acceptance by the Client

I have read and understand this information, clarified my concerns, and agree to undertake counselling with Jake Forrest. I understand that I can conclude my sessions at any time.

Client’s Name: __________________________________
Client’s Signature: ______________________________
Counsellor’s Name: _____________________________
Counsellor’s Signature: __________________________
Date: ___________