child psychologist

Vicki Williams Psychology payment consent form

Complete this form to consent to Vicki collecting, securely storing and using your credit or debit card details for automatic payment of fees after your session.

Please note that there is a card processing fee of 1.9% plus $1 per transaction. If the form is not working please email adminteam@vickiwilliamspsychology.com.au

  • Disclaimer and Consent

    All our services and your use of this website are subject to our Privacy Policy and the Terms and Conditions listed below:
  • 1. Vicki Williams 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 - Vicki Williams 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. Cancellation Policy - If you wish to cancel or re-schedule an appointment without cost, we require at least 24 hours notice. Session bookings cancelled within 24 hours of the appointment time the full session fee will be deducted from your stored card or invoiced.

    4. All payments will show up on your credit or debit card statement/online banking with the payment reference 'Halaxy' (NOT Vicki Williams Psychology)