Consent

All clients are requested to familiarise themselves with the terms and conditions that underpin entering into a professional service agreement with a psychologist.

RECITALS:

WHEREAS, Client is desirous of implementing psychological services into the Client's mental health & relationship wellbeing, as discussed more fully below;

WHEREAS, Psychologist is skilled and capable in the areas Client needs and would like to assess and treat Client;

NOW, therefore, in consideration of the promises and covenants contained herein, the receipt and sufficiency of which is acknowledged, the Parties do hereby agree as follows:

1 - SCOPE:

This Agreement sets forth the terms and conditions whereby Psychologist agrees to provide professional psychological Services (as described below).
Psychologist will be engaged for the limited purpose of providing these services to the Client.

2 - NO EMPLOYMENT:

Neither party is by virtue of this Agreement authorized as an agent, employee, or legal representative of the other.
Neither party shall have the power to control the activities and operations of the other and its status at all times will continue to be that of an independent contractor relationship.

3 - SERVICES TERMS:

A therapeutic relationship between two Parties is essentially a relationship whereby the Psychologist assists the Client in meeting the Client's mental health and relational well-being needs within the areas the therapeutic relationship is meant to focus on.

Client hereby acknowledges and agrees:

While the Client understands that the Psychologist is committed to providing treatment in line with current best practice in clinical psychology, and expect benefits from the treatment, the Client also accepts that particular benefits and outcomes cannot be guaranteed.
Client is solely and exclusively responsible for the choices that Client makes with regard to this therapeutic relationship, as well as the Psychologist's recommendations and input;
Client is solely and exclusively responsible for Client's own mental health, physical health, business decisions, and any other actions or inaction Client chooses to take;

4 - DESCRIPTION OF SERVICES:

The Client hereby engages the Psychologist, and the Psychologist accepts such engagement to provide the following psychological services for the Client (hereinafter, the "Services"):

Clinical Psychological Evaluation, including clinical interviews, psychometric testing and mental status examination.
Psychotherapy, including out-of-session materials designed for the purposes of aiding or enhancing psychotherapy objectives.
Couple's Therapy if so desired by Client.

5 - CONFIDENTIALITY:

The existence of this therapeutic relationship, as well as any information that Psychologist receives from Client, are to be fully and completely confidential under the terms of this Agreement.
Client hereby acknowledges and agrees, however, that a Psychologist-Client relationship is not considered a legally confidential relationship and therefore communications between Psychologist and Client are not subject to any legal confidentiality requirement or privilege.
Psychologist will not, however, disclose Client's name or any of Client's information without Client's consent, unless subject to a legal requirement, such as a court order, subpoena, or law enforcement inquiry. It will be the Client's responsibility to address any confidentiality issues with the Psychologist.
Confidential information under this Agreement shall specifically not include the following categories: (1) information that is generally known to the public or known to Client's specific industry, (2) information freely given by Client to any third-party; (3) information received by Psychologist from any source that is not Client; (4) information in Psychologist's possession prior to this contractual Agreement; (5) information developed independently by the Psychologist; (6) information which is received by the Psychologist from the Client but that may imminently harm the Client or another individual; or (7) information about any illegal activity.

6 - NON-EXCLUSIVITY:

Psychologist may be engaged or employed in any other consultant business, trade, profession, or other activity which does not place Psychologist in a conflict of interest with the Client.
Client hereby explicitly acknowledges and agrees that Psychologist may be engaged or employed with any other business or industry, including, if applicable, Client's direct competitors.

7 - CANCELLATIONS & RESCHEDULE POLICY

This practice has a 24 hour cancellation policy.
The Client is to cancel their appointments within 24 hours if they are unable to attend.
In the case of non-cancellation or when a Client does not arrive for a scheduled appointment, the full consultation fee will be charged.
These fees are not paid by the medical aid provider and will remain the responsibility of the person responsible for payments.

8 - FEES

Client will be billed through an invoicing system either weekly or monthly with invoices to be sent either directly to the client or medical aid. This will be clarified during initial meeting between the Parties.
The Client remains responsible for the entire invoice if and for whatever reason the medical aid provider refuses to settle the invoice.
The Client remains responsible for payment of any shortfall not covered by the medical aid provider.
Medical aid providers require diagnostic coding (ICD-10 code) in order to pay an invoice.

The rate for Psychologist, as of 01 February 2025 will be as follows:

Intake Session of 90 minutes - R2000.00
Psychotherapy session of 51- 60 minutes - R1350.00 This rate will include all forms of communication, such as meetings, calls, emails, etc.

This rate does not include any EXTRA PROGRAMS offered by the Psychologist designed for individual or couple's wellbeing such as DBT, Leadership Coaching, etc.
Should the Client's invoice not be settled within 90 days, the Psychologist retains the right to hand over the account for external debt collection. The Client will be liable for the additional costs that may arise as a result.

9 - RECORD RETENTION POLICY:

Psychologist and Client hereby acknowledge and agree that they have specifically discussed Psychologist's record retention policy.
Psychologist will maintain communications, documents, information, and notes related to Client, in a manner most convenient for Psychologist.
Psychologist utilises the most recent digital recording media specifically designed for professional record keeping.
All Client documents are digitally stored with the necessary security encryption mechanisms in place.
All efforts will be made to safeguard Client confidential information / records, in accordance with the Protection of Personal Information Act 4 of 2013 (POPIA). As far as possible, Psychologist will endeavour to limit the risk of Client personal information being exposed through circumstances, such as theft, loss, damage or unauthorised access.

10- SUPERSESSION:

Client is not currently undergoing treatment with another psychologist or psychological counsellor (or, if Client is, Client has discussed this with Psychologist). This does not inlcude consultation with a PSYCHIATRIST, as clinical psychologists and psychiatrist often work together treating the same client.

11 - LIMITATION OF LIABILITY:

Psychologist's liability in contract, tort or otherwise arising through or in connection with this Agreement or through or in connection with the completion of obligations under this Agreement shall be limited to Fees paid by the Client to the Psychologist.
To the extent it is lawful, neither Party shall be liable to the other Party in contract, tort, negligence, breach of statutory duty or otherwise for any loss, damage, costs or expenses of any nature whatsoever incurred or suffered by that other Party of an indirect or consequential nature including without limitation any economic loss, data loss, loss of goodwill, or other loss of turnover, profits, or business.

12 - INDEMNIFICATION:

Psychologist and Client shall each defend, indemnify, and hold the other harmless (including all affiliates, officers, directors, employees, agents, successors, and assigns) from and against all losses, damages, liabilities, deficiencies, actions, judgments, interest, awards, penalties, fines, costs, or expenses of whatever kind (including reasonable attorneys' fees) arising out of or resulting from bodily injury, death of any person, or damage, real or intangible, to personal property resulting from the other's acts or omissions or the breach of any representation, warranty, or obligation under this Agreement.

13 - SURVIVAL:

Any provision of this Agreement which by its terms imposes continuing obligations on either of the Parties shall survive termination of this Agreement.

14 - CARRYING OF CONCEALED FIREARM DURING CONSULTATIONS

1. Permitted Possession and Disclosure

1.1 The Client may carry a legal firearm during consultations, provided that:
1.1.1 The firearm is legally owned by the Client, with a valid firearm license issued by the South African Police Service in accordance with the Firearms Control Act, 60 of 2000.
1.1.2 The Client discloses to the Psychologist at the commencement of any consultation that he/she is carrying a firearm.
1.2 The Client must ensure that the firearm is:
1.2.1 Properly concealed at all times in accordance with applicable laws.
1.2.2 Securely controlled to prevent unauthorized access or accidental discharge.

2. Duty of Disclosure and Risk Assessment

2.1 By entering this agreement, the Client acknowledges the Psychologist’s professional and ethical obligations under the Health Professions Amendment Act, 2007, to assess and address any risks to safety arising from the Client’s mental health in the context of firearm possession.
2.2 The Client agrees that:
2.2.1 The Psychologist has the right to inquire into the Client's mental health status, as relevant to the safe possession of a firearm.
2.2.2 The Psychologist may take reasonable actions to address potential risks of injury or death, including but not limited to:
- Notifying the Designated Firearms Officer at the South African Police Service in cases where a risk to the Client, the Psychologist, or any other person is identified.

3. Acknowledgment of Responsibility and Consent

3.1 The Client accepts full responsibility for complying with all legal obligations relating to firearm possession and use under the Firearms Control Act, 60 of 2000.
3.2 The Client provides informed consent for the Psychologist to take necessary safety-related steps as stipulated in clause 2.2 if a risk is identified during the course of treatment.

4. Limitation of Liability

4.1 The Psychologist shall not be held liable for any consequences arising from the Client’s failure to comply with legal obligations or the terms of this agreement regarding firearm possession.
4.2 The Client indemnifies the Psychologist against any claims, losses, or damages resulting from incidents involving the Client’s firearm during or related to consultations.

4- FORCE MAJEURE:

Psychologist is not liable for any failure to perform due to causes beyond its reasonable control including, but not limited to, acts of God, acts of civil authorities, acts of military authorities, riots, embargoes, acts of nature and natural disasters, and other acts which may be due to unforeseen circumstances.

15 - COMMUNICATION

Client is aware that information may be transmitted electronically via Quenza App, NovoPsych, NovoNote, Appointment Guru App, Email, SMS or Whatsapp.
Although measures have been taken to safe guard Client's personal information during electronic transmissions, Client is aware that there is a risk of breach of confidentiality inherent in the electronic transmission of information.
Client is aware that online therapy sessions are conducted via Zoom video conferencing software.
In the event of an after hours’ emergency, Client should contact the nearest hospital emergency room for assistance

16 - ONLINE CONSULTATIONS

1. Platform and Access Requirements

1.1 The Psychologist conducts online consultations through the Microsoft Teams platform.
1.2 The Client is responsible for ensuring:
1.2.1 Access to a stable and secure internet connection.
1.2.2 A private, quiet, and distraction-free environment conducive to confidentiality and effective engagement during the session.

2. Technological and Environmental Responsibility

2.1 The Client acknowledges that it is their responsibility to:
2.1.1 Set up and test the Microsoft Teams platform and equipment prior to the session.
2.1.2 Inform the Psychologist promptly if any technical difficulties arise that may impact the consultation.
2.1.3 Safeguard their device against unauthorized access and maintain their confidentiality during and after the session.

3. Confidentiality and Disruptions

3.1 While the Psychologist will take reasonable measures to protect confidentiality, the Client acknowledges that online consultations inherently involve certain risks, including but not limited to:
3.1.1 Potential unauthorized access due to security vulnerabilities.
3.1.2 Disruptions caused by unstable internet connections or technical issues.
3.2 In the event of any technological failure, including but not limited to power outages, unstable internet, or interruptions on the Microsoft Teams platform:
3.2.1 The Psychologist will make reasonable efforts to reconnect or reschedule the session.
3.2.2 The Psychologist is not liable for any inconvenience, emotional distress, or other consequences resulting from such disruptions.

4. Rescheduling and Termination of Session

4.1 If a session cannot proceed due to technical issues or environmental distractions on the Client’s side, the Psychologist reserves the right to:
4.1.1 Reschedule the session at a mutually agreed time.
4.1.2 End the session if the conditions outlined in clause 1.2 are not met.
4.2 The Client agrees to bear any costs incurred for a missed or disrupted session caused by failing to meet these requirements, as per the Psychologist’s cancellation policy.

5. Limitation of Liability

5.1 The Psychologist shall not be held liable for:
5.1.1 Technical issues beyond their control, including but not limited to power outages, platform malfunctions, or internet instability.
5.1.2 Breaches of confidentiality arising from the Client’s failure to ensure the security of their device or environment.

17 - PSYCHOLOGICAL REPORTS

Clinical reports such as progress reports or reports requested for other purposes e.g. employers or legal practitioners based on Client's clinical consultations can be prepared at additional costs to Client.

18 - ENTIRE AGREEMENT

The agreement embodies the entire agreement between the Psychologist and Client relating to the subject matter hereof.
This Agreement may be changed, modified, or discharged only if agreed to in writing by both parties.