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Informed Client Consent and Agreement for Therapy

Thank you for your interest in therapy services with us at Elisheva Wellness! We ask for a little of your time to read this document carefully before your initial consultation.

Privacy Policy 


By accessing or using any of our services you acknowledge you have read our Privacy Policy in accordance with the Privacy Act 1988 (Cth) (the Privacy Act), available at

Informed Client Consent and Agreement for Therapy


In order to provide quality assessment and therapeutic services, Practitioners at the Practice will collect and record personal information relevant to you and your situation. 

Purpose of collecting and holding information


Any personal information gathered as part of your assessment and treatment process will be kept securely and, in the interests of your privacy, used only by your Practitioner and the authorised personnel of the Practice (as necessary). Your personal information is retained in order to document what happens during sessions, assisting your Practitioner to provide a relevant and informed service to you.


Access to client information


You are entitled to access your personal information kept on file, unless relevant legislation states otherwise. If you require access to your information, please discuss this with your Practitioner.


Disclosure of personal information


Personal information gathered by your Practitioner during the provision of services is considered confidential and will not be disclosed to another party except when:

  • your prior approval has been obtained (the client must sign a written release of information indicating informed consent to such release); or

  • it is subpoenaed by a court; or

  • failure to disclose the information would in the reasonable belief of your Practitioner place you or another person at serious risk of harm; or

  • disclosure is otherwise required by law.


Appointment schedule and payment policy


A non-refundable booking deposit of $55 is taken upon booking your 1-1 initial consultation to secure the appointment. The deposit is deducted off the initial consultation fee and is valid for 1 month and can only be rescheduled one time or an additional booking fee will apply (subject to your Practitioner’s availability). 


Full or partial payment shall be made online or in person at the end of each session by the client. The client understands that a Practitioner will not be able to receive health insurance reimbursement under many health provider policies. The client is fully responsible for the payment of all fees.


Accounts can be paid via credit card or debit card. All client information is kept private and confidential.


Cancellation policy 


Cancellation or rescheduling of appointments must take place 24 hours prior to appointment. Booking fees cannot be refunded. Full session fees are payable if cancellation occurs less than 24 hours prior to appointment, payment needs to be made prior to the next session. Most health insurance companies will not reimburse you, the client, for this charge.


Initial consultation is required to commence treatment, all other appointments are discussed with your Practitioner as treatment progresses.


Fee Agreement 


Our fees are available on our website at Fees may be subject to change; you will be informed before your next session if fees were to change. 


Work Agreement


The client shall make an effort in good faith at personal growth and engage in the therapy as an important priority at this time in their life.  Client gain is most important in therapy. The client agrees to undertake any homework required to the best of their ability.  Suspension, termination, or referral shall be discussed between Practitioner and client in the case of a pattern of behaviour that reveals disinterest or lack of commitment to therapy, or for any unresolved conflict or impasse between the Practitioner and the client.


The Practitioner and the client further agree that an agreed treatment plan will be drawn up at the second session, with future revisions possible as the need arises.


Therapy will be limited to a maximum of 24 sessions. Therapy shall be terminated either at the client’s request or when the client returns to full functionality or a referral for further treatment may be made at any time, whichever is in the client’s best interest.


Further questions

For any further question, please visit the FAQ section on our website, or contact us via

 ‘Practitioner’ referred to in this document include Psychotherapists, Counsellors and Hypnotherapists providing professional services at the Practice.

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