child psychologist

Information, Consent, and $180 Payment Form

Please complete the below form to pay your $180 appointment fee via a secure banking portal with NAB (you will be directed to this payment page when you submit the form).  All future appointment payments will be debited from this card you provide unless you provide us with an alternative card. No other payment methods are possible. If this form is not working or you have any questions please call 0410974435 or email us at

  • Southern Highlands Psychology Terms and Conditions

    All our services and your use of this website are subject to our Privacy Policy and the Terms and Conditions listed below:
  • 1. Dr Andrew Franland of Southern Highlands Psychology is your "treating psychologist" responsible for your care, you are "the client" (yourself or the child or adolescent you are organising services for), and Changes Psychology is the admin and billing service "provider" that is only responsible for processing clients' bookings, billing and client administration only on behalf of your treating psychologist. By signing this agreement you are agreeing to the provision of services under this arrangement

    2.Privacy - Southern Highlands Psychology takes your privacy seriously. We work like a virtual clinic office, collecting and managing personal and medical information digitally from you and your psychologist, which naturally includes sensitive health information. We collect, use and (where appropriate) store this information, which includes health information, in order to facilitate appointments with psychologists; manage payment, medicare and insurance claims; and manage records regarding your appointments. We manage your information in accordance with our ethical guidelines. For more about privacy, and who to contact if you have questions or complaints regarding privacy, see our Privacy Policy.

    3. Your treating psychologist will not provide information, reports or documentation for medico-legal or family court related purposes unless required to by law, under a subpoena or by a court order.

    4. Parenting plans - if there is a parenting plan in place we require the parent or person engaging the treatment to meet all requirements of the plan.

    5. Information sharing - If you would like the psychologist to share and collect information about your child with your ex-partner, you child's teacher, or any other persons, we need written consent from you to approve this sharing of information with each individual. However if you intend to claim rebates from Medicare or another organisation is paying for the services, then your psychologist must provide summary reports to the referring GP, Paediatrician, Psychiatrist or external agencies regarding your treatment progress in order to be able to give you Medicare rebates and meet the legal obligations of this funding. By agreeing to these terms and conditions you agree to this information sharing policy and the details outlined in our Privacy Policy and in this Information, Consent and Payment form.

    6. Confirming your first appointment booking - To confirm the first session booking, all new clients are required to complete the Information, Consent, and Payment Form via the online form and payment portal link that will be emailed to you within 48 hours of receiving the confirmation email. Your card details will be processed for the $1 deposit only and your card details stored securely encrypted within the NAB (National Australia Bank) Transact system and be used to deduct all future session fee payments and all other fees when they are owed

    7. Cancellation Policy - If you wish to cancel or re-schedule a session without cost, we require more than 24 hours notice. A cancellation fee equivalent to 50% of the standard fee may be charged if you fail to attend an appointment without prior notice or cancel on the day of the appointment to cover some of the impact of this cancellation.

    8. The fee for a standard therapy session is currently $180 and may increase yearly to cover practice costs. This fee covers each 50-minute session, brief phone consultations, liaising with referring professionals, and general administration. Payment for sessions needs to be received before Medicare rebates are processed. All session fee and cancellation fee payments will be taken via our online payment system NAB Transact after sessions occur, direct deposits are not a payment option. All payments will show up on your credit or debit card statement/online banking with the payment reference 'Changes Psychology Northgate' (NOT Southern Highlands Psychology)

  • Price: $ 180.00
  • $ 0.00