Child Parent Consent form

In most circumstances, we recommend that all legal parents/guardians are aware of the child attending our clinic for assessment and therapy. In the initial parent session, we can discuss the process of both legal parents/guardians being contacted to confirm the child's referral and treatment. We understand that in some circumstances this may not be appropriate and will discuss this with the parent initially presenting their child to therapy.

Regardless of the decision to inform the other parent, both parents are entitled to be involved in their child's treatment and upon request, the treating Psychologist will provide feedback sessions to both parents regarding the child's progress in therapy (in most instances, with permission from your child). These sessions and any emails or phone calls are paid consultations. Our fee schedule can be found here.

If your child is 15 or over, they may be able to provide their own consent for treatment. Medicare enables children to apply for their own Medicare card from the age of 15 and legal guardians are not able to access these records. We will always notify you of any safety concerns regarding your child.

Where Consent Orders are in place giving only one parent sole legal responsibility for the child, these Orders will need to be provided to the clinician prior to your initial appointment.

Unless we are appointed as a single expert witness by the Court, please note that we do not provide forensic psychological services, including the writing of court documentation/reports. If subpoenaed by a court of law, only all currently existing documentation will be provided as requested in the subpoena. This service attracts a fee.

Child attending therapy (client)

Child First Name *

Child Last Name *

Date of Birth *

Are the child's biological parents/legal guardians separated? *

YesNo

If yes, are there Orders in place granting one parent/guardian sole legal responsibility for the child?

YesNo N/A

Is the child attending for a formal assessment, therapy or both? *

Formal Assessment (i.e., educational or behavioural assessment)TherapyBoth

Payment, late fees and travel obligations

It is essential to establish clarity regarding the parental responsibility for the payment of session fees and late notice fees for the non-attendance of sessions, as well as the arrangement for transportation to and from therapy sessions for the child.

Please provide information below regarding these items. Please note that if there are specific arrangements for the responsibility of each parent on particular days, this must be outlined.

First and last name of person(s) responsible for payment of session fees *

First and last name of person(s) responsible for payment of late notice fees *This also includes who is responsible for providing a medical certificate if cancellation is due to sickness

First and last name of person(s) responsible for transportation of the child to and from therapy *

Your Details and Consent for the Child

Your First and Last Name (Person Completing Form) *

I have read and understood the Separated Families Policy Document *

I have read and understood the Release of Treatment Notes Policy Here *

Signed *

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Other Parent/Guardian Information and Consent

Do we have your permission to contact the other legal Parent/Guradian to inform them that therapy has started? *

Yes - You can email this form immediately to them and I will provide their details belowYes - I will provide their details now but would like to speak with the psychologist first before contacting themNoUnsure

Other Guardian/Parent First Name

Other Parent/Guardian Last Name

Other Guardian/Parent Mobile

Other Guardian/Parent Email Address

Other Parent/Guardian Signature/Consent

(Other Parent/Guardian) I have read and understood the Release of Treatment Notes Policy Here *

(Other Parent/Guardian) I have read and understood the Separated Families Policy Document *

Other guardian First and Last Name

Signature

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If you have indicated above that there are Orders in place granting you sole responsibility for your child, please forward this to admin@aresolution.com.au prior to your child's initial appointment.