Consent to Treatment - Incolink Counselling and Support Service

Consent to Treatment

  • I freely consent to participate in counselling at Incolink Counselling and Support Service.
  • I understand that there will be no fees for as long as I remain an active Incolink member and/or my family member is an active Incolink member.
  • I acknowledge Incolink’s Privacy Policy and I consent to the collection, use and disclosure of my personal information which includes sensitive information and any other information I have provided Incolink Counselling and Support Services. I understand that it will at all times remain confidential, except to authorised Incolink personnel for the purpose, where the law demands otherwise, or where the counsellor has grounds for believing that the client will cause serious harm to others or themselves.
  • I understand that de-identified information I provide will be utilised to improve service outcomes.
  • I reserve the right to cease counselling at any time.
  • I understand that the Counsellor is undergoing regular clinical supervision and professional development.
  • I have read the privacy declaration below.

Privacy Statement

The information we collect on this form is to enable us to provide services on the basis of correct and up to date information. Your personal information will be maintained securely. If you would like further information on Incolink privacy policy please contact the Management on (03) 9639 3000 or refer to our website.