INFORMED CONSENT FOR PSYCHOLOGICAL SERVICES

As part of providing a psychological service, including assessments and counselling, Dr Kylie Hinde will need to collect and record personal information pertaining to yours and your child's current situation. This information is a necessary part of the psychological assessment and treatment.

Psychology services vary depending on the personalities of the psychologist and client and the particular reasons you are seeing a psychologist. Dr Kylie Hinde may use many different methods to deal with the problems that you hope to address. Psychology and psychotherapy require a very active effort on your part as the parent. For the therapy to be most successful, you will have to work on things we talk about both during your child's sessions, our parent sessions and at home.

Our first few sessions will involve evaluating yours and your child's needs. By the end of the evaluation, Dr Kylie Hinde will be able to offer you some first impressions of what our work will include and a treatment plan to follow. If you have questions about the procedures, you and Kylie Hinde should discuss them when they arise. You can cease therapy with Dr Kylie Hinde at any time. If you feel uncomfortable with what is happening in a session, you may request that the session cease at any time.

Dr Kylie Hinde is committed to respecting and incorporating cultural safety into practice. Please inform her about any cultural considerations that are important to you in the way services are provided and who you would like involved in yours and your child's care. Please also inform her if you or your child have specific access support needs (ramps, accessible parking, resources provided in specific formats), communication support needs such as interpreting, the use of assistive technology, or resources provided in different languages, or any other support needs in order to assist your participation.

*Please note:This form is also issued to all parents or guardians of child clients. It is recommended parent/s or guardian/s discuss or review sections of my forms with their dependents, as deemed appropriate. Please ensure that you have provided your contact information in my New Client Information and Referral details form.

Consent and the nature and limits are also discussed in the initial appointment with each client to confirm understanding and answer any questions.

Access to your Information

Relevant personal information about the current situation will be collected and recorded as part of providing psychological services. The information will assist in providing appropriate and thorough service. The information will be stored in a secure location. Psychologists are required to keep your file for a minimum of 7 years or, if clients are under the age of 18 at the time of treatment, until they are 25 years of age.

Client files are uploaded to the clinic’s practice management software, and any hard-copy documents are securely shredded and disposed of.

Note that all parents or guardians of child clients would usually have a right to access information that is contained in their file.  You may access the information in your child’s file on request, subject to the exceptions in the Privacy Act 1988 (https://www.legislation.gov.au/C2004A03712/latest/text). If your child is assessed as a mature minor, this may impact what information you are able to access regarding their treatment if they do not consent to this information being shared with you. However, if there are issues of risk, harm, or potential harm to your child, you will be informed.

Confidentiality and Privacy

If information about you is required from another person, such as a parent or partner, this will be discussed with you beforehand, and your permission will be sought. Please note that Dr Kylie Hinde will not engage with you in public or online in a way that will identify you as a client. This is to protect your privacy and due to the requirements to uphold professional boundaries. Please personally contact her to engage with her rather than approach them on social media or in public forums.

All personal information gathered by Dr Kylie Hinde during the provision of psychological service will remain confidential and secure except when:

• A court subpoena or other disclosure is required or authorised by law. Please note that from 5th July 2021, all adults in Queensland are now legally obliged to report any sexual offence currently and historically committed against a minor.

• Your consent cannot be gained due to a requirement to get you emergency services during a medical crisis

• If there is unauthorised access to data held by the clinic some limited information may need to be shared with the Office of the Information Ombudsman. 

• Failure to disclose the information would place you or another person at risk of harm

• Given your prior approval or consent of a parent or guardian who is legally authorised to act on your behalf to provide a written report to another professional or agency or discuss information with another person, e.g., parent or employer

• You have provided your consent to share your information for a specific reason and purpose.

• You would reasonably expect your personal information to be disclosed to another professional or agency, and disclosure is directly related to the primary purpose for which it was collected, such as to inform your GP of treatment and progress, to claim Medicare rebates on your behalf etc.

• Clinical consultation with another professional is required to provide better services. If this occurs, identifying details will remain confidential.

If, during your child’s treatment, if Dr Kylie Hinde becomes aware of a risk to someone’s life, health, or well-being, she is required to report the matter to the appropriate agencies.

A client's personal information is not disclosed to overseas recipients unless the client consents or such disclosure is otherwise required by law. Clients' personal information will not be used, sold, rented, or disclosed for any other purpose.

Please see the Privacy Policy for Management of Personal Information for further information.

Session Fees (Please see Fee list - fees will be reviewed in January each year)

• Individual clinical psychology sessions as of January 1st 2026 both In-clinic and Telehealth will be charged @ $298 per session

Reports and letter writing:

All reports and letter writing outside of required Mental Health Treatment Plans GP summary letters will involve an additional cost and should be discussed with Dr Kylie Hinde. These are charged by the hour and in accordance with Dr Kylie Hinde's session fee structure above with GST added to any outside of session report or letter writing ($298 p/hr + GST).

Attendance at other allied health meetings:

Dr Kylie Hinde's attendance at other allied health meetings is billed at $298 per hour *excluding any additional travel time costs

Private health fund rebates:

It is your responsibility to check your coverage and eligibility with your private health fund and confirm if rebates apply to your psychological service. Unfortunately, I am unable to know how much your private health fund will cover and I encourage you to contact your health fund to determine this. Please note that I am unable to automatically process rebates on your behalf. It is your responsibility to submit a copy of your invoice and receipt to the relevant organisation in order to claim your rebate.

Medicare rebates:

If you are eligible for Medicare rebates, CDN administration can assist in processing patient claims through the practice software. Please note, I do not hold responsibility for eligibility or the processing of Medicare rebates.

Under the Medicare Benefits Schedule (Better Access), Medicare rebates are available to clients with an assessed mental disorder. Medicare rebates are accessed with a Mental Health Treatment Plan and referral from a medical practitioner such as a GP, psychiatrist, or paediatrician. The rebate is limited to a maximum of 10 sessions per calendar year and is only available with a valid referral. Please note the maximum number of sessions per referral is six, and rebates will not be given beyond the number stated on the referral.

Please note: The APS recommends an hourly rate for psychological services of $311/40-60 minute consultation (2024-2025 financial year). 

Please see the following link:
https://psychology.org.au/psychology/about-psychology/what-it-costs/private-practice-services 

The APPI recommends a fee of $330/40-60minute consultation:
https://www.aapi.org.au/common/Uploaded%20files/AAPi/2025-2026%20AAPi%20Recommended%20Fees%20detailed.pdf

Late Cancellation, Rescheduling and Non-attendance Policies

The intention of this policy is to allow for appointment gaps created by cancellations and rescheduling to be offered to other families in need of the services provided by Dr Kylie Hinde at CDN.

The services and appointments provided by Dr Kylie Hinde from CDN are highly specific and involve several years of training and professional development. As such these services are in high demand. However, if you cancel or reschedule an appointment at late notice, or do not attend a booked appointment, we are unable to re-fill the appointment time slot.

For these reasons, all appointments that are cancelled or rescheduled with less notice than 2 full business days will be charged a late cancellation/ rescheduling fee of 100% of the booked consultation.

Likewise, if you do not attend for a booked appointment, you will be charged a non-attendance fee of 100% of the booked consultation.

This fee is not eligible for a rebate from Medicare.

This fee must be paid before any further services are provided by Clinicians who consult at CDN.

If you wish to discuss the waiver of the fee, please send a written request. Letter or email is acceptable requesting the fee to be waived with an explanation Attention to Dr Kylie Hinde. Emails can be sent to cdn@cd.net.au   .

Any final decision to waive the late cancellation, rescheduling or non-attend fee is made by Dr Kylie Hinde. It cannot be done by the administrative staff.

Recurrent Cancellations

The provision of high-quality care to children, young people and families requires a commitment on the part of the individual/family to the therapeutic process, including attending appointments at the time intervals recommended by their therapists and clinicians.

Clinicians recognise that sometimes circumstances may change at short notice and that this may prevent the family’s capacity to attend a scheduled appointment, however a pattern of recurrent cancellations can be detrimental to the child and young person’s clinical care and the therapeutic process as a whole. It can also prevent other families from accessing this valuable service.

For these reasons, if a family/individual demonstrates a pattern (e.g. 3 episodes) of late cancellations, late rebookings or missed appointments, their clinician may return their care to their GP, and they will no longer be offered appointments through the Child Development Network.

Consent to Psychological Assessment and Reports

I understand that as part of my care, Dr Kylie Hinde may conduct psychological assessments to evaluate my child's cognitive, emotional, behavioural, or other psychological functioning, including assessment of neurodivergence (e.g., Autism Spectrum Disorder, ADHD, or other neurodevelopmental profiles). These assessments may involve standardised tests, questionnaires, clinical interviews, or observations. Any assessments will be conducted in consultation with the parent/carer and the child (where appropriate).

If assessment is recommended a discussion will be undertaken with you prior to any testing being initiated. The results of these assessments will be used to inform your child’s treatment, care planning, and recommendations. A written report summarising the findings may be prepared and shared with you. With your written consent, these reports may also be provided to other professionals involved in my care (e.g., GP, psychiatrist, or other AHPRA-registered providers). You have the right to discuss the content of the report, ask questions, and request clarification of any findings.

Zero Tolerance of Aggression Policy

The safety and wellbeing of all individuals - including clients, administration, and the clinician are a priority. CDN maintains a zero-tolerance policy for abuse or aggression. Any display of such behaviour, in any form, during contact with Dr Kylie Hinde or any other staff member at CDN may result in the withdrawal of services or other appropriate action.

Professional Boundaries and Dual Relationships

Dr Kylie Hinde maintains a strong stance on professional boundaries in accordance with the Psychology Board of Australia’s Code of Conduct. Maintaining clear professional relationships is essential to provide safe, effective, and ethical care.

Multiple or dual relationships (e.g., where a client may also be a friend, colleague, or family member) are generally avoided. If a multiple relationship is unavoidable, it will be carefully assessed and managed to ensure that your care remains professional, ethical, and free from conflicts of interest. Any such arrangements will be discussed transparently and documented.

The principle of “once a client, always a client” applies: Dr Kylie Hinde will not engage in relationships outside the professional context that could compromise your therapeutic care, even after formal treatment has concluded.

Social media and personal contact: Kylie Hinde does not accept friend requests or personal contact on social media platforms with current or former clients. Any professional communication will be conducted through secure and appropriate channels (e.g., clinic email, phone, or practice management software).

These measures are in place to protect both your safety and the integrity of the therapeutic relationship.

Referral and Transition of Care

In accordance with the Psychology Board of Australia’s Code of Conduct, Dr Kylie Hinde is committed to ensuring that clients receive care that remains within the clinician’s scope of competence and ethical practice. If your circumstances or clinical needs change and fall outside this scope, Dr Kylie Hinde will work collaboratively with you to identify and link you with an alternative AHPRA-registered provider who is appropriately qualified to meet your needs.

To support continuity of care, Dr Kylie Hinde must ensure that you have engaged with another AHPRA-registered provider prior to discharge. If you do not wish to pursue further treatment, you may choose to decline this transition; however, this decision must be provided in writing.

Contingency Planning

In the event that Dr Kylie Hinde is unable to continue providing care (for example, due to changes in my health or death), the following clinical psychologist has agreed to support your child's ongoing treatment:

Rebecca Kuhn
Email: psychologist@kuhn.id.au
Website: rebecca.kuhn.id.au

To ensure continuity of care in this unlikely situation, this will mean that Rebecca Kuhn may access your child's personal information for the purpose of contacting you and facilitating ongoing support.

If Rebecca is unable to provide care, please present to your usual GP, another AHPRA-registered provider, or an appropriate specialist. In the event of an emergency, please call 000 or attend your nearest emergency department.

Rebecca Kuhn will notify you of any relevant changes via email, phone, or SMS.

Contingency planning is a requirement under the new AHPRA Code of Conduct effective from the 1st of December 2025: https://psychology.org.au/about-us/what-we-do/code-of-conduct

Use of Therapy Materials and Use of Artificial Intelligence

Session recordings or material won't be used for purposes beyond delivering service without your written consent. Likewise, please refrain from recording sessions or using session material for purposes other than therapy without seeking consent.

In line with Australian Health Practitioner Regulation Agency (AHPRA) requirements, psychologists are required to keep accurate, factual, and up-to-date records. To help meet this standard, Dr Kylie Hinde uses Heidi Health, an AI medical scribing tool.  This tool creates secure summaries from audio recordings of sessions, improving the accuracy of notes and allowing Dr Kylie Hinde to dedicate more time to planning and delivering your care.  All processing (including speech-to-text transcription, redaction, and storage) is securely managed within Australia in compliance with privacy legislation. Audio files are destroyed immediately after transcription. Transcripts are automatically redacted to remove identifying details and then encrypted using AES-256 bit bank-level encryption for the highest level of protection.  Your consent is required for the use of AI scribing in your sessions. You may withdraw this consent at any time without it affecting your access to therapy.

What you need to know   

1. Purpose of Heidi

• Heidi is used to assist with documenting your consultation, capturing only what is necessary for accurate medical records.

• Heidi supports but does not replace your clinician’s professional judgment. All therapy decisions are made solely by your clinician.

• Your data is processed and stored in your jurisdiction and in accordance with applicable privacy laws.

• None of your data is used for secondary purposes. Data undergoes a rigorous de- identification process to remove personal identifiers. Data is handled securely, with encryption and regular audits to ensure compliance.

2. Your rights:

You can choose to opt-out of the use of Heidi during your consultation. By signing this consent form and ticking ‘Yes, I consent’, you acknowledge that:

• You have been informed about the use of Heidi and its purpose.

• You understand how your information will be handled, stored, and protected.

• You agree to allow your clinician to use Heidi to assist with documenting your consultation.

• You understand that you can withdraw your consent at any time without affecting the quality of care you receive.

Consent for Communication

The practice offers clients/guardians the opportunity to communicate by email, phone and SMS for some limited purposes. This form provides information about the risks of email, how Dr Kylie Hinde will protect yours and your child's information and your responsibilities regarding communication. This practice will also use this form to document your consent to communicate with you by email, phone, post and SMS.

Email, phone call, and SMS is not appropriate for urgent or emergency situations, nor is it a substitute for face-to-face or telephone/telehealth consultations.

Any communication between you and the practice will be added to your client file and retained for a minimum of 7 years, or if clients are under the age of 18 at the time of treatment, until they are 25 years of age.  As all client-communication is part of a client file, other individuals authorised to access the file will have access to that communication.

Files of clients are held in a physical filing on the clinic’s practice management software.

You may access the information in your file on request, subject to the exceptions in the Privacy Act 1988 (https://www.legislation.gov.au/C2004A03712/latest/text). 

As email, phone calls, and SMS communication forms part of your client file, this information will be kept confidential and secure except when:

• A court subpoena or other disclosure is required or authorised by law

• Your consent cannot be gained due to a requirement to get you emergency services during a medical crisis

• If there is unauthorised access to data held by the clinic some limited information may need to be shared with the Office of the Information Ombudsman. 

• Failure to disclose the information would place you or another person at risk of harm

• Given your prior approval or consent of a parent or guardian who is legally authorised to act on your behalf to provide a written report to another professional or agency or discuss information with another person, e.g., parent or employer

• You have provided your consent to share your information for a specific reason and purpose.

• You would reasonably expect your personal information to be disclosed to another professional or agency, and disclosure is directly related to the primary purpose for which it was collected, such as to inform your GP of treatment and progress, to claim Medicare rebates on your behalf etc.

• Clinical consultation with another professional is required to provide better services. If this occurs, identifying details will remain confidential. 

Risks:

Communication by email has several risks, including, but not limited to, the following:

• The practice cannot guarantee that an email, phone call, or SMS will be read or responded to. For example, in email, security software can filter emails before it reaches us and the intended recipient may go on personal leave unexpectedly. 

• Email can be circulated, forwarded, and stored in paper and electronic files.

• Backup copies of the email may exist even after the sender or recipient has deleted their copy.

• Email or SMS senders can easily misaddress an email or SMS, or unintended recipients can receive an email or SMS.

• Email can be intercepted, altered, forwarded, or used without authorisation or detection.

• Employers and online services have a right to archive and inspect emails transmitted through their systems.

• Administration staff may also receive your emails and SMS before forwarding them to your healthcare provider.

How Dr Kylie Hinde at CDN will protect your information:

The practice will use reasonable means to protect the security and confidentiality of email information sent and received. However, because of the risks outlined above, Dr Kylie Hinde cannot guarantee the security and privacy of email communication, and she will not be liable for the inadvertent disclosure of confidential information.

Dr Kylie Hinde will encrypt any documents we need to send you via email and forward the password to access this file by another communication method (phone or text message or personally known pin information e.g., DOB).

Dr Kylie Hinde will verify your email prior to sending any confidential information.

When emailing you, Dr Kylie Hinde will:

• Put any identifying information in the body of the email, not in the subject line.

• Include the general topic of the message in the email's subject line, for example, 'advice' or 'appointment'.

Client responsibilities around the use of email, phone, and SMS:

• I will inform the practice of email address and phone number changes.

• When emailing or SMSing a healthcare professional, the practice will:

  • Not put identifying information in the SMS or email's subject line but will put this in the body of the email.

  • Include the general topic of the message in the email's subject line, for example, 'advice' or 'appointment'.

• I [the client] will contact the health care professional's office via alternative communication methods, if a reply is not received within a reasonable period of time.

• I will not use email, phone or SMS to communicate urgent or emergency information.

• I will not use email, phone, SMS, for communication regarding sensitive medical information, unless I choose to do so understanding the risks stated in this consent form.

• I am responsible for informing the healthcare professional of any information that I do not want to be sent by email or SMS.

• I am responsible for protecting my password or other means of access to email. The health care professional is not liable for breaches of confidentiality caused by me or any third party.

The client also understands:

That emails and any attachments may contain confidential information and may be protected by copyright. You must not use or disclose them other than for the purposes for which they were supplied. The confidentiality of the email and attachments is not waived by reason of mistaken delivery to you. If you are not the intended recipient, you must not use, disclose, retain, forward or reproduce this message or any attachments. If you receive this message in error, please notify the sender by return email, SMS, or phone and destroy and delete all copies; and

Is aware that the internet is not a secure environment. Dr Kylie Hinde cannot control the path of inbound and outbound emails, so she cannot guarantee the privacy of personal information sent by email. The client is aware of this risk if they choose to communicate with Kylie Hinde by email and include their personal details.

Communication Between Sessions:

Interactions via email, phone, and SMS outside of scheduled sessions will be minimised, primarily focusing on administrative matters such as appointment arrangements, updates, information exchange with specialists, and resource sharing. Lengthy emails will be reviewed during the next scheduled session, but it's advised against sharing sensitive information through these channels due to privacy and confidentiality concerns.

Consent for Professional Supervision

To support high-quality clinical care, Dr Kylie Hinde participates in regular professional supervision. I understand that my clinician may discuss aspects of my child's case with a qualified supervisor or through peer consultation for the purpose of improving treatment, ensuring ethical practice, and maintaining clinical competence.

Any information shared in supervision will be de-identified to protect my child's privacy, and supervisors are bound by the same standards of confidentiality as practising clinicians.

I understand I can decline to participate in, or withdraw from proposed services at any time. Consent will need to be reviewed and signed every 12 months or in the event that the client's circumstances change. Any consent provided will be terminated at the end of treatment after discharge and other necessary administration has been completed.

Consent for Telehealth

In addition to our general “Informed Consent Form”, which includes information about confidentiality and its limits, information storage, informed consent to treatment, and consent to exchange information, we ask that you read and sign this specific Telehealth Client Informed Consent Form.

By signing this consent form, I agree that:

I understand that the benefits of telehealth/video conferencing therapy sessions can include:

• Continued access to my psychologist.

• Continued therapeutic support as part of my treatment plan.

• Avoiding the need for me to travel to my psychologist.

I also understand that there are potential risks and downsides of telehealth/video conferencing therapy sessions and that these can include:

• Telehealth/video conferencing may not feel the same as face-to-face sessions.

• Technical problems could affect the video/sound quality or connection, which may disrupt the session in some ways.

• Although my psychologist chooses video conferencing software, which has end-to-end encryption and high-security standards, there is still a small risk of hacking or others tapping into the video connection.

I understand that my psychologist is taking the necessary precautions to ensure confidentiality, including:

• Ensuring the privacy of the telehealth session is upheld in the same way an in-person session would be, by choosing a private location or using headphones.

• Not allowing any voice or video recording of the session.

I have been informed of and understand the payment and or Medicare processes for my telehealth session, and I consent to comply with these.

I understand that I can ask questions about the telehealth session anytime.  I understand that attending a telehealth/video conferencing session is not compulsory, and I can withdraw consent at any time.

If I do not wish to continue or if technical difficulties interfere with the session to the point where we cannot continue, a phone consultation will be offered as an alternative.

Psychological Services Consent Statement

I have read and understood the contents and information in this consent form and have been given the opportunity to ask questions regarding its contents with Dr Kylie Hinde. I agree to the conditions outlined in this form, including the associated fee I am required to pay, and to receiving treatment from Dr Kylie Hinde of CDN. I understand I can decline to participate in, or withdraw from proposed services at any time.

Consent will need to be reviewed and signed every 12 monthsor in the event that the client's circumstances change. Any consent provided will be terminated at the end of treatment after discharge and other necessary administration has been completed. I understand I can decline to participate in, or withdraw from proposed services at any time.

If you have any questions or uncertainties about the information provided, please contact me before your appointment.

Please note: If, after reading this page you are at all unsure of what is written, please discuss it directly with Dr Kylie Hinde.