About this resource
This form explains Medicare rebates, reports to the referrer, confidentiality and its limits, fees, and records, in plain language.
Purpose
A consent form for psychologists covering fees, Medicare, confidentiality, records, telehealth and reports to GPs.
Who it is for
Primary profession: Psychologists. Also relevant for counsellors and therapists, allied health and multidisciplinary teams.
Client or participant group: Practitioners and teams.
Practice setting: Psychology practices.
Suggested uses
- New client pack
- Reviewing consent
- Provisional psychologist practice
Instructions for practitioners
- Add your details and delete what does not apply.
- Check it against your professional requirements.
- Explain it to the person in plain language.
- Store completed copies securely.
Accessibility considerations
Clear headings and tables. The Word version can be edited and filled in on screen.
Scope and limitations
A template for adaptation. It is not legal advice. Check it against your professional body's requirements, your insurer's advice and the law where you work.
Research basis
Health service providers must handle health information in line with the Privacy Act and Australian Privacy Principles, including telling people what is collected and why, and obtaining consent where required. Under Better Access, a referral covers a course of treatment of up to 6 services, with up to 10 individual services in a calendar year. Allied health professionals must give the referring practitioner a written report after each course of treatment, covering assessments, treatment and recommendations.
- Department of Health, Disability and Ageing. (2025). Better Access redesign from 1 November 2025. https://www.health.gov.au/sites/default/files/2025-10/better-access-redesign-from-1-november-2025_0.pdf
- Department of Health, Disability and Ageing. (2026). AskMBS advisory: Allied health services, Part B: Mental health treatment. https://www.health.gov.au/sites/default/files/2026-03/askmbs-advisory-allied-health-services-part-b-mental-health-treatment.pdf
- Office of the Australian Information Commissioner. Guide to health privacy. https://www.oaic.gov.au/privacy/privacy-guidance-for-organisations-and-government-agencies/health-service-providers/guide-to-health-privacy
What is included
A 2-page printable A4 PDF, including a practitioner notes page with the research basis (version 1.0).
Originality
Original Practitioner Plus content: wording, activity structure, layout and icons were created for this resource. No third-party worksheets, illustrations or text were reproduced. Written for Practitioner Plus from the sources in the research basis.
