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Client Information & Acknowledgment Form - Victims Services

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Consent & Acknowledgement

Anthony Hansen Counselling is committed to providing you with quality services (by phone or zoom) to support you.


The Purpose of Counselling

Counselling funded by Victims Services is intended to support your recovery from the psychological impacts of the act of violence you experienced.


Our sessions will focus on helping you process your experiences, strengthen coping strategies, and support your wellbeing moving forward.


Privacy and Confidentiality

Your privacy is very important and what you share in counselling is treated confidentially.


There are some limits to confidentiality. These may include situations where:

  • there is a risk of harm to yourself or someone else

  • information is required by law

  • limited information needs to be provided to Victims Services in relation to your approved counselling (such as attendance or requests for additional sessions)


Where possible, I will always discuss this with you first.


I understand that Anthony Hansen Counselling will document notes of our meetings and communications.


My personal or health information will be treated as confidential and in a way which complies with the Privacy and Personal Information Protection Act 1998 (NSW) and/or the Health Records and Information Privacy Act 2002 (NSW), as well as Anthony Hansen Counselling's Privacy and Confidentiality policy.


I have a right to make a formal complaint if I am dissatisfied with the way in which my personal and/or health information is collected, stored, used or disclosed (for more information about how your personal information is kept, please refer to the Anthony Hansen Counselling Fact Sheet).


This acknowledgement remains in force until Anthony Hansen Counselling closes my file (unless I advise otherwise).

 

Your Approved Counselling Sessions

Victims Services provides a set number of counselling hours.


These hours are used for:

  • counselling sessions

  • brief administrative work related to your counselling where required


If additional support is needed after your approved sessions are used, I can request additional counselling hours from Victims Services where appropriate.


Clients who experienced sexual assault or physical abuse in NSW before the age of 18 may be eligible for ongoing counselling support.

 

Attending Sessions with Others

In some situations, clients may wish to attend a session with a family member or another person who has also been approved for Victims Services counselling.


This can only occur when:

  • each person attending has their own Victims Services approval

  • each person has available counselling hours

  • everyone provides informed consent


For safety reasons, an alleged perpetrator cannot attend a counselling session with the person they are alleged to have harmed.

 

Certificates of Injury

If you are applying for financial assistance or a recognition payment through Victims Services, you may ask me to complete a Certificate of Injury.


This document confirms that you have experienced a psychological injury related to the act of violence. The completed certificate will be provided directly to you.

 

Missed Appointments

Victims Services allows up to two missed appointments per counselling claim.


A missed appointment occurs when a client:

  • does not attend their session, and

  • provides less than one business day’s notice of cancellation.


Victims Services will cover two missed appointments only.


If you need to cancel or reschedule, please try to provide at least one business day’s notice.

 

Additional Supports

If needed, I may also help connect you with other services that can support you. This may include:

  • crisis or mental health support services

  • court support services if you are involved in legal proceedings

  • housing support services

  • NDIS support services

I have read and agree to the above.

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