Preliminary Information Form

Please fill out the following form before your first appointment

* indicates required field

 

PERSONAL DETAILS

 

YOUR GP'S DETAILS

 

EMERGENCY CONTACT

 

Depression Anxiety Stress Scales (DASS) form

Please download and complete this DASS form no more than a week prior to attending your first session.
If filling out this form distresses you please contact Peter Langdon on 0409954707 or Life Line on 131 114.


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Terms of Service

 

Psychological Services Agreement

Psychological services provided by Peter Langdon – Registered Psychologist are counselling and assessment to provide treatment for your specified condition or situation. Individual goals and treatment strategies will be discussed and written up as a service plan. This is usually reviewed after 6 sessions or at a point of need or concern.

Information collection

In providing psychological services to you, Peter Langdon, will need to collect and record personal information that is relevant to your current situation. This is part of the assessment and treatment plan, of which you will be informed of the nature and content of your personal record.

Confidentiality

All personal information gathered by the psychologist will remain confidential and secure, except where:

1. The file is subpoenaed by court; or,

2. Failure to do so would place you, or another person at serious and imminent risk; or,

3. Your prior approval has been obtained to discuss your case with other concerned parties: eg: GP, Allied Health Professional, Lawyer, TAC, WorkSafe, Guardian, or other family members.

Fees and cancellation policy

Accounts are to be settled on the day of consultation unless otherwise specified. If you need to cancel your appointment time, 24 hours notice would be appreciated – otherwise a $60 fee will be charged.