Forms

Rainbow Consulting Limited www.rainbowconsulting.nz info@rainbowconsulting.nz

 

Online Therapy  Welcome to working with Shelley Harvill (Rainbow Consulting)

 

Informed Consent:

It’s very important to me that you know what to expect from our therapeutic alliance. Working online is a little different than working with someone in the same location and it changes confidentiality a little too. Here is some important information for you to consider.

 

Appointments:

When you start working with me the first session after our free pre engagement one will probably be focussed on me getting a good picture of what is going on for you and in the first two sessions we will likely come up with some goals or a focus of the work. Our work will likely include some tasks for you to try or things for you to think about between sessions if this is something that you are willing to engage with.

 

Cancellations and missed appointments:

If you can’t attend an appointment please give me as much notice as possible. With the exception of infrequent unforeseen emergencies and illness, you will be charged the full fee for short notice cancellation or non attendance, as it doesn’t give me enough time to offer your appointment to someone who is waiting. 

I require at least 48 hours notice for cancellation or rescheduling to avoid a full session fee charge.

 

Contact 

Between appointments I am only contactable in order to change or confirm appointment times. I am unfortunately not available for support between sessions. I also ask that we come off social media if you found me on Facebook. With your consent I’ll email you information and resources from time to time.

 

Confidentiality 

Appointments will be held on Zoom unless you request Messenger or WhatsApp. Zoom states that:  

“Your meetings are yours. We do not monitor them or even store them after your meeting is done unless we are requested to record and store them by the meeting host. We alert participants via both audio and video when they join meetings if the host is recording a meeting, and participants have the option to leave the meeting”. 

Despite best efforts however, working online is not completely free from risk of a breach of privacy and it’s important that you are aware of this.

 

Record Keeping

I will take notes and keep them in a locked filing cabinet or utilising an online service via my password protected laptop. I may ask you to send me information via email from time to time. I may also ask you to complete questionnaires and scan them back to me. Please be aware that confidentiality on email, text and messenger is not absolute so if you are not comfortable with this we can talk about options.

 

Safety: 

Your safety is the most important thing. If you are currently in a crisis that poses a risk to yourself or to others (for example in a violent relationship or actively suicidal) online therapy is not the best way for you to receive help because I am not connected to crisis and emergency services near you. In such cases we will talk about options so you can make alternative arrangements.

 

Email & Digital communication

I put the privacy & security of the client at a high priority. Therefore, I have put efforts into ensuring that the communication is error and virus-free, by using reputable providers. Unfortunately, full security of emails or session invitations cannot be guaranteed as, despite my efforts, the data included in emails could be infected, intercepted, or corrupted. Therefore, the recipient should check the email for threats with proper software, as the sender does not accept liability for any damage inflicted by viewing the content of this email.

 

Overseas Online Therapy Informed Consent:

I am a registered Clinical Psychologist in New Zealand and subject to a rigorous code of ethics and practice guidelines. I have a Bachelors, Masters and Doctorate in Clinical Psychology. However, please be aware that if you don’t live in NZ,  I am not registered to practice in your country. There are no laws against this, but it may impact on your ability to have any complaints you make against me pursued, as the scope of the New Zealand Psychologists’ board might be limited in such cases. Practices around working internationally are evolving. If you want to find out what this might mean in your area, please contact your local (State or Country)  psychologists’ registration board to discuss it with them. I am happy to talk with them at your request. 

Special Services

Some services (I.e. EMDR, Trauma Processing, Report Writing, Assessments  Etc.) may require additional time outside of the session, and will be charged at the hourly rate by prior agreement. 

 

For all inquiries about my service including fees etc please contact info@rainbowconsulting.nz

Invoicing and payments are handled by Rainbow Consulting who provide my administrative services.

 

Sessions are 60 minutes with additional  increments of 15 minutes as needed and agreed with you.

In exceptional circumstances I offer a sliding scale based on need. 

 

Payment from within New Zealand:

Cost $195 NZD for Individual 60min sessions, $215 for more than one participant (60min), by direct bank transfer only. Receipts can be provided on request. 

 

Please make payment to Rainbow Consulting. Payment is required within 7 days of the session date.

 

Payments can be made to:



Kiwibank 

Account name:
 Rainbow Consulting 

Account Number: 38-9022-0150326-02

 

Payment from Out of New Zealand:

Cost USD$140 for Individual 60min sessions, USD$155 for more than one participant (60min). If you live outside New Zealand payment can be made using our PayPal account by prior arrangement. 

Invoices/ receipts can be provided on request.

 

Please sign below to indicate your understanding and consent (you can save the form as a pdf and sign it electronically or print and sign it and take a photo of it to email to me, or scan it and email it to me). If you have technical difficulty with this, please let me know.

Note: If Therapy involves more than 1 person, please ensure everyone signs below.
 

 

Name: __________________________ Name: _________________________________

 

Email: __________________________ Email: _________________________________

 

Signature: __________________________ Signature: _________________________________ 

 

Date: __________________________ Date: __________________________

 

Status:  NZ Resident ___  /  Out of New Zealand  ____

 

Emergency Contact Emergency Contact

 

Name: _________________________       Name:       _______________________________

 

Relationship: _________________________ Relationship: _______________________________

 

Address: _________________________ Address:            _______________________________

_________________________ _______________________________

 

Phone Number: _________________________ Phone Number: _______________________________    

 

General Practitioner: 

 

Name ________________________ Clinic ________________________ 

 

Phone Number ________________________ Email ________________________

 

With Many Thanks,

Dr. Shelley Harvill (Rainbow Consulting)

New Zealand Registered Clinical Psychologist

Member NZPS