Purpose of this Form
This document outlines the terms, conditions and consent requirements for participating in therapy with Caris Pepper, including both face-to-face and telehealth (online) sessions. It explains how your personal information will be used, your rights as a client, the potential risks and benefits of therapy, and practice policies. By signing this form, you are giving informed consent to participate.
Collection & Use of Information
I need to collect information about you for the primary purpose of providing a quality service. Your information may also be used for:
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Administrative purposes of running the practice
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Billing, either directly or through an agency
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Communication with your doctors or other health professionals involved in your care
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Supervision and professional development (de-identified unless required for continuity of care)
I do not disclose your personal information to other recipients without your consent, except in circumstances of legal or ethical obligation (e.g. risk of harm).
You can read the full Privacy Policy at www.carispepper.com. This policy explains how your information is collected, used, disclosed, stored, and how you may request access, correction, or lodge a privacy complaint.
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Arts Therapy and Energy Healing are complementary approaches and are not substitutes for medical treatment or prescribed medication.
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You are encouraged to continue working with your primary caregiver or treating team for any health conditions.
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You are responsible for informing your therapist of any known medical, physical, or psychological conditions, and for updating them if these change.
Definition: Telehealth involves using phone, video, or secure online platforms to provide therapy.
Participation:
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You will need a private space free from interruptions, a stable internet connection, and (for video) a device with a camera and microphone.
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Sessions may involve creative activities such as drawing, writing, or drama.
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A support person may be present with you if desired.
Potential Benefits:
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Increased access to therapy
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Reduced need for travel
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Continuity of care
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Reduced exposure to infectious illness
Potential Risks:
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Technical issues (e.g. dropouts, poor quality audio/video)
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Privacy and digital security risks (though all reasonable measures are taken to protect confidentiality)
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May feel different from in-person sessions
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May not be suitable for all clients (e.g. those with sensory processing challenges or discomfort with technology)
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You acknowledge that therapy supports you in making your own decisions and creating your own outcomes. Advice or suggestions may be offered, but responsibility for choices and actions rests with you.
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You have the right to ask questions about therapy, including telehealth.
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You may accept or decline any part of the service, at any time, including during a session.
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You may withdraw consent verbally or in writing, and this will be noted in your record.
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You may request information about alternatives to telehealth.
- The content of therapy sessions is kept strictly confidential, except where: there is a risk to your safety or the safety of others, disclosure is required by law, or mandatory reporting obligations apply (for example, in relation to children and young people).
- Clients under 18: Confidentiality and safety are prioritised. Information is shared only on a need-to-know basis. If a child’s safety or wellbeing is at risk, I am legally required to notify the relevant authorities or individuals to ensure protection and welfare.
- Session notes are stored securely and accessible only to your therapist (and, if relevant, a supervisor).
- Information may be shared with another professional only with your explicit consent.
- Clients are not permitted to audio- or video-record sessions without prior agreement.
- Sessions may be recorded by the therapist for the purpose of accurate note-taking. These recordings are protected under the Privacy Act 1988 (Cth), are not modified or shared, and are securely stored.
All sessions for individuals under 18 years of age require an initial session with the parent/guardian to discuss the child’s therapy needs and ensure a comprehensive understanding of the family context.
The Client shall indemnify and hold Caris Pepper and Caris Pepper Creative Therapies harmless from any loss, claim, or liability arising from actions taken or situations created as a result of participation in, or following, any session or program.
By participating in any individual or group session, program, workshop, retreat, or service—whether in person or online—offered by Caris Pepper Creative Therapies, you acknowledge that you are engaging in a process of self-exploration, creative expression, and personal growth by your own free choice. You understand that arts therapy, energy healing, and other holistic or creative modalities offered are complementary wellbeing practices, and are not substitutes for medical, psychological, or psychiatric care.
You agree that your participation is entirely voluntary, and that you remain fully responsible for your own wellbeing, choices, actions, and outcomes during and after sessions. You are encouraged to practise discernment, make autonomous decisions that align with your own values and needs, and seek additional professional advice where appropriate.
You understand that within group settings, confidentiality, respect, and mutual care are essential, and that you are responsible for maintaining appropriate personal boundaries and conduct. You participate with an awareness that others are also engaging in their own personal processes.
To the fullest extent permitted by law, you agree to indemnify, defend, and hold harmless Caris Pepper, Caris Pepper Creative Therapies, and any affiliated facilitators, assistants, contractors, or representatives from any and all claims, liabilities, losses, damages, costs, or expenses (including reasonable legal fees) arising directly or indirectly from your participation, decisions, interpretations, or actions taken as a result of any session, service, or information provided.
By proceeding, you acknowledge that you have read, understood, and freely consent to this agreement, and that you take full responsibility for your own physical, emotional, mental, and spiritual wellbeing throughout your engagement with Caris Pepper Creative Therapies.
- Payments for sessions are to be pre-paid.
- Rescheduling must occur within 7 days of the original booking. A session may only be rescheduled once.
If you are unable to attend you rescheduled session, you will forfeit your payment - At least 24 hours’ notice is required for cancellation or rescheduling. Cancellations with less than 24 hours’ notice will incur the full fee.
- Refunds may be requested in writing and are subject to a $50 administration fee. Emergency cancellations are at the therapist’s discretion.
By signing below, I confirm that:
- I understand the purpose of this form and the information provided.
- I consent to participate in arts therapy and/or energy healing sessions, including via telehealth.
- I understand the potential benefits and risks of therapy.
- I understand my rights to privacy, confidentiality, and access to my records.
- I declare that all information I have provided is true and complete, and I will update my therapist with any changes.
- I have read, understood, and agree to the policies outlined above.
