St Peters House Intake Form

Please read the terms and conditions and then fill in the form below to engage in counselling at St Peters House

Counselling Terms & Conditions
 
 
Confidentiality

• Your information, including what you say in counselling, will not be shared with anyone outside of St Peters House without your permission.  
• If you have been referred by another service, we will let the referrer know you have started counselling. For PHO referrals a final report will be given to the PHO which will be supplied to your doctor as part of your clinical care. No further information will be shared without your permission.
• Your information or notes may be reviewed by our Team Leader, during supervision, or by an external auditor, however, we only use first names and limit the information shared.
• All records are stored securely at St Peters House.  You can request to read or get a copy of your session notes if you wish.
• It is important for all participants that online sessions use secure software and the environment in which we hold the session is uninterrupted and maintains confidentiality.

Exceptions to Confidentiality

• We will break confidentiality if your counsellor considers there is serious risk to your safety, the safety of others, or property is threatened, then the counsellor will need to let the relevant people know to ensure the safety of those at risk.  Whenever possible this will be discussed with you first.

Sessions at St Peters House

• St Peters House is a short-term counselling centre and offers up to 10 sessions in person, via zoom or phone.
• Your first 6 sessions are fully subsidised, so we can offer them to you free of charge. If you need more than 6 sessions you may have up to 4 additional sessions, a fee applies for these additional sessions (see table over the page).
• Each session lasts 50 minutes to 1 hour. 
• For Health & Safety reasons, please check in at reception on entry to St Peters House.
• It is not our practice to have children in counselling sessions, however, exceptions can be made e.g. for breastfed babies, please discuss this with your counsellor.
• We will work together to establish goals that relate to the main issues you have come to counselling about.  These will guide your counselling and be reviewed on session 6 and/or when completing counselling.

Appointment Cancellation Policy
Our services are in very high demand.  We limit the number of sessions we offer and have policies on missed appointments so we can work with as many people as possible and minimise the waiting times for new clients.
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• You will receive a confirmation email 3 days before your appointment and a reminder text the morning before your appointment. 
• If you can’t make an appointment please give at least 48 hours’ notice by phone or text to our reception on 571 5916  or  022 045 6087 (reception hours are 8:30am - 3pm, Tuesday - Friday).
• Appointment changes with less than 48 hours’ notice are considered a missed appointment.
  • Missed appointments within the first 6 sessions count as one of your subsidised sessions.
  • Missed appointments after 6 sessions will be charged at your session rate to a maximum of $40.
  • Only 2 missed appointments will be accepted. A 3rd missed appointment may end your counselling with us.
• You, or your counsellor, may end counselling at any time. Reasons for ending counselling may include, but are not limited to: excessive missed appointments, therapy goals met, change of circumstance, counselling not being beneficial, client’s requirements not suited to our agency. If you are not finding counselling helpful or your circumstances have changed, please let your counsellor know.

Counsellor Ethics and Complaints

• Counsellors at St Peters House follow the ethical guidelines set by the national counselling organisations and are always expected to act in an ethical way.
• If you are unhappy with how you have been treated by your counsellor and wish to make a complaint you can talk to the Team Leader (Denise Coy) or Manager (Cath Page).

Payment Guideline After 6 Subsidised Sessions

Weekly Household Income	Session Rate	Subsidy	Your Rate
Up to $600	$140	$130	$10
$600 - $1000	$140	$120	$20
$1000 - $1500	$140	$100	$40
​$1500 and above	$140	$80	$60+

Payments can be made in cash or with eftpos at reception or by Internet Banking.
St Peters Care & Counselling Charitable Trust
Bank Account 01-0434-0365728-000
Please use as references Counselling, your name, and your counsellor’s name. 
This allows us to allocate the payments you have made correctly.