Coastal Mind Matters
Counselling Agreement, Confidentiality and Privacy Consent Form
Counsellor: Naomi Lindenberg (ACA Registered Counsellor 5841)
Phone: 0456 905407
coastalmindmatters.com.au
COUNSELLING AGREEMENT
Welcome to Coastal Mind Matters. This agreement outlines the counselling relationship and provides information about confidentiality, privacy, and client rights and responsibilities.
Counselling is a collaborative process designed to support personal growth, emotional wellbeing, and positive change. While counselling can be highly beneficial, no guarantees can be made regarding specific outcomes.
COUNSELLOR RESPONSIBILITIES
As your counsellor, I will:
Provide a safe, respectful, and non-judgmental environment.
Work within my professional qualifications, competence, and ethical guidelines.
Respect your dignity, values, and personal choices.
Maintain confidentiality within the limits outlined below.
Encourage open communication regarding your goals and concerns.
CLIENT RESPONSIBILITIES
As a client, I agree to:
Participate actively and honestly in the counselling process.
Provide accurate information relevant to counselling.
Treat the counsellor respectfully.
Notify the counsellor if I need to cancel or reschedule an appointment.
CONFIDENTIALITY
All information disclosed during counselling sessions is treated as confidential and will not be shared with third parties without your consent, except where required by law or ethical obligations.
Confidentiality may be limited when:
There is a serious and imminent risk of harm to yourself.
There is a serious and imminent risk of harm to another person.
Disclosure is required by law, court order, subpoena, or mandatory reporting obligations.
Information relating to abuse, neglect, or exploitation where reporting is legally required.
Professional consultation or supervision is sought to ensure quality of care (your identifying information will be protected wherever possible).
Where practical and appropriate, confidentiality limitations will be discussed with youbefore any disclosure occurs.
PRIVACY STATEMENT
Coastal Mind Matters collects personal information necessary to provide counselling services.
This information may include:
Your information is stored securely and is accessible only to authorised persons.
Records will be retained and managed in accordance with applicable Australian privacy laws and professional requirements.
You may request access to your personal information, subject to legal and professional limitations.
TELEHEALTH AND ONLINE SESSIONS
Where counselling is conducted online or by telephone:
Reasonable steps will be taken to protect your privacy and confidentiality.
Technology risks, including unauthorised access or technical failures, cannot be completely eliminated.
Clients are encouraged to participate from a private location where confidentiality can be maintained.
CANCELLATION POLICY
Please provide at least 24 hours notice if you need to cancel or reschedule an appointment.
Failure to provide adequate notice amy result in a cancellation fee at the counsellor's discretion.
CLIENT CONSENT
I acknowledge that:
I have read and understood this Counselling Agreement, Confidentiality and Privacy Consent/Intake Form.
I understand the limits of confidentiality.
I understand how my personal information will be collected, used, and stored.
I consent to participate in counselling services provided by Coastal Mind Matters.
I have had the opportunity to ask questions regarding this agreement.