Welcome to our Practice

This document contains the agreement between us. It sets out the terms and conditions of our practice and provides you with essential information. We will gladly discuss any questions you might have about this agreement, and you can request a copy from us at any time.

Informed Consent for Services to be Rendered

• A successful relationship between us depends, amongst other things, upon mutual trust. To contribute to this trust relationship, we will orally provide you with sufficient information for you to make continuous informed decisions about the treatment we provide. In turn, it is your duty to continuously enquire about anything regarding the treatment that you wish to know or do not understand. Receiving treatment from us is always voluntary and you can refuse treatment at any stage.
• Should any form of tests, assessment, evaluation, or diagnostic service be required, we will orally explain to you the exact nature of such procedure. Your participation in this procedure will be entirely voluntary and you can refuse to participate therein at any stage. Again, it is your duty to timeously enquire about anything regarding the procedure that you wish to know or do not understand. We do not do psycholegal work. Therefore, our therapy sessions cannot be formulated into a report or utilized for court purposes. We focus purely on therapeutic work.

ICD-10 Codes

• An ICD-10 code is a description of our clinical diagnosis of your condition that would be submitted to medical aid, if you choose this form of payment. We will orally explain to you the meaning of the ICD-10 code we provide during your consultations. It is your duty to timeously enquire about anything regarding this ICD-10 code that you wish to know or do not understand. Please note that we do not have any control over the management and utilization of your ICD-10 information by your medical aid. We encourage you to ensure that you are aware of your medical aid's rules in so far as the confidentiality of this information is concerned.

Prescribed Minimum Benefits (PMBs)

• These are a set of defined minimum health benefits that all medical scheme members have access to, regardless of the benefit option they have selected.
• It is important to understand the following:
  • We can only apply for a condition that is specified on the official list of PMB’s
  • We cannot diagnose a condition that you do not have and will not apply for a PMB for a condition that you do not meet the criteria for.
• Before commencing with the application for a PMB, it is important that you carefully consider any possible consequences of such an application. These are, mainly:
  • If we use out-patient sessions for your treatment, and you require an in-patient admission later in the year, you may not have access to a further PMB, as we would have used a portion, or all the benefit for your treatment by us.
  • Applications made for a PMB require disclosure of your diagnosed condition and, in some instances, a letter of motivation also needs to be submitted. This means that sensitive information about you will be provided to your medical aid. This may have a future impact in a few areas, such as loaded life insurance policies and immigration challenges, however this is not guaranteed.
• Should you wish to apply for a PMB, there are several ways in which we are able to use these for your treatment, so that we are able to maximise the benefit to you. We also want to be sure to manage the benefit efficiently and share it with other providers. If we can successfully apply for a PMB, we will discuss this in more detail.

Telehealth consultations (Online consultations)

• With the COVID-19 pandemic in mind, telehealth consultations provide an important social-distancing safety precaution. It is also a time-saving option. Should you be interested in this type of consultation, this can be discussed during the initial consultation with your therapist/ health practitioner.
• The negative side of telehealth consultations includes a lack of the intrinsic visual and audio interaction that forms part of a face-to-face conversation. These are important consultation tools, and, in some circumstances, the absence of these tools might hamper us in providing you with efficient assistance.
• Should your therapist/ health practitioner, at any stage during your consultations, be in doubt whether telehealth consultations are in your best interest, we will advise you that you should have a face-to-face consultation to assess your situation. You can refuse to do so, but we reserve the right to cease further telehealth consultations if we believe this to be in your best interest.
• Since the internet-link between us might not always be stable, telehealth consultations can be interrupted by technical glitches. This can be very disruptive, and you should be willing to accept the possibility of this type of interruption if you choose to have telehealth consultations. There is also a risk, albeit small, that a telehealth consultation can be intercepted by a third-party. We do not record telehealth consultations unless specifically agreed with you and/or your guardian (if applicable).

Cost of Treatment & Payment

• At the commencement of your treatment, and thereafter whenever a change occurs, we will provide you with a written quotation that sets out the exact amount payable per consultation.
• Upon your request, we will gladly provide you with a statement of account.
• Appointments are taken as confirmed when we confirm it with you telephonically or via WhatsApp. If you do not cancel your appointment at least 24 hours prior to your scheduled appointment, or if you do not attend the appointment, you will be charged in full for the appointment. A missed appointment will be invoiced as such, and your medical aid (if applicable) will not pay for the missed appointment.
• Should we, for whatever reason, come to an alternative fee arrangement, such arrangement needs to be recorded in writing by us and we must provide you with a copy. If this is not done, no alleged alternative fee arrangement will be valid.
• For the drafting of reports or letters and the completion of forms (other than a PMB form), we charge on a time basis at the pro rata rate applicable to your consultations. Your medical aid will not cover this service and we will provide you with an invoice for it. We expect our invoices to be settled before we hand over the report, letter or completed forms that you requested from us.
• A 25% administration fee will be charged on all accounts handed over for debt collection.

Terms and conditions for payment via medical aid

• Our fees will be commensurate with the annual rate specified by your medical aid.
• Once your medical aid benefits for psychology or related services are depleted, our fee arrangement will default to cash payments as set out hereunder.
• We will claim our fees directly from your medical aid, but, strictly subject to the following conditions:
  • You remain primarily responsible for payment of our fees, and you undertake to promptly settle any fee that might be rejected by your medical aid, for whatever reason;
  • You assume full responsibility for all administrative interactions with your medical aid. For instance:
    • it is your responsibility to establish from your medical aid whether it will cover your consultations with us and, if so, to what extent;
    • it is your responsibility to continuously keep track of how many of your consultations your medical aid will still pay for; and
    • you must take up any rejected claim with your medical aid, should you not agree with the rejection.

Terms and conditions for cash payments

• If you do not make use of a medical aid to settle our accounts, we will charge you in accordance with the quotation that we will provide to you when you sign this agreement. We will provide you with further written quotations as and when our rates change. You are expected to settle your account at the end of the month, and we reserve the right to terminate this agreement should you not do so.
• At the end of the month, we will provide you with an invoice that is immediately payable. Payment is required via EFT.

Duration of Consultations

• The duration of a consultation is a maximum of 50 minutes. If you are late for your appointment, you will have a shorter session and will still be charged for a 50-minute session. Consultations cannot run overtime as this will negatively impact the time of the person scheduled after you.
• If you are running late for a consultation, please inform us. If you fail to do so, we will wait for 15 minutes, whereafter we will consider the appointment as a missed session, and we may not be available thereafter.

Communication between us

• For administrative matters it is best to contact our receptionist at 076 932 9254 or to email us at conciouspsychologyza@gmail.com. Your therapist/ health practitioner will not be able to answer your call or respond to your e-mail when he/she is busy in a consultation. He/she will respond as soon as possible.
• For telehealth consultations, we recommend that Google Meet be used. This is a cloud-based video conferencing service used to virtually meet. You can easily download this application to your cell phone or your computer.
• Office hours are 08h00 to 17h00 (MST) on weekdays and 08h00 to 13h00 on Saturdays. We are not available outside of these hours. In case of emergencies, if you are not able to reach us, please contact your general practitioner (GP) or nearest emergency room. Please make sure to obtain these telephone numbers in advance.

Indemnifications

• Personal Safety: Whilst we take reasonable precautionary measures, we are not able to ensure your safety when visiting our practice. Thus, when entering the property on which our practice is situated, you (or your guardian, where applicable) assume full responsibility for your own safety as well as those accompanying you. We, our staff, our landlord or any other persons associated with our practice cannot be held liable for any injury or material damage that might befall you, or any person who accompanies you, whilst on the property. To this extent you (or your guardian, where applicable) indemnify us, our staff, our landlord and all other persons associated with our practice against any claim (including claims by dependents), of whatever nature, arising out of, or associated with injury or material loss suffered by you or any other person that might accompany you whilst on the property.
• Damage to property: Should you in any manner damage anything on the property on which our practice is situated, you (or your guardian, where applicable) agree to re-imburse the injured party fully for the expense incurred to repair the damage caused by you.
• Disclosure of confidential information: We will not knowingly divulge any information regarding yourself unless we are faced with one of the exceptions mentioned below. However, we do not accept any responsibility for damage caused by a breach of information pertaining to you and you (or your guardian, where applicable) indemnify us against loss or liability that might result from such a breach of information.

Information provided in terms of the Protection of Personal Information Act, 2013

• Confidentiality:
  • The very nature of mental health services requires the gathering of personal information from you and other relevant person/s (the latter being case dependent).
  • The personal information that you provide, is subject to an obligation of confidentiality by virtue of the profession under which our practice falls, as well as South African legislation and the rules of the Health Professions Council of South Africa (the “HPCSA”). All personal information provided will be treated as strictly confidential, except under the following circumstances:
    • with your express consent (and/or that of your guardian, where applicable) to disclose personal information;
    • in providing information required by your medical aid or other person responsible for payment of our professional fees (where applicable) to process claims for professional services provided by us. Please note that medical aids require an ICD-10 Code that divulges our clinical diagnosis of your psychological condition and that we have no control over their management of your personal information;
    • where we are reasonably required to use the services of a debt collecting agency or attorney to collect outstanding amounts due and owing to us;
    • where we are obliged to divulge information in a court of law or in terms of a statutory provision or because it is in the public interest;
    • where consultation with other mental health professionals is viewed as being necessary;
    • where you pose a danger to yourself or another person; and
    • in the case of a deceased client, with the written consent of the next of kin or the executor of the deceased’s estate.
• Information security:
  • You may be advised of appointments and other administrative details via telephone, WhatsApp and/or e-mail.
  • All personal information is collected from you during consultations or, in exceptional circumstances, from other relevant persons indicated by you.
  • The personal information collected by us will be used exclusively to direct your mental health sessions to reach a mutually agreed upon desired outcome. The personal information is provided on a voluntary basis. However, withholding information will likely have a negative impact on the services rendered by us.
  • Your personal information gathered will only be shared with persons outside of our practice after discussion with you and with your consent (and/or that of your guardian, where applicable).
  • Ms Naran and your therapist/ health practitioner are responsible for maintaining the security of the personal information you provide us with.
  • All personal information is stored in a safe environment and, where applicable, in encrypted electronic format.
  • All information collected will be stored for a period of 6 (six) years as from the date on which you cease consulting us or as otherwise provided by the HPCSA. Hereafter, the information will be destroyed, again in accordance with the guidelines provided by the HPSCA.
  • Our practice’s website is secured by means of an SSL certificate and we take reasonable measures to ensure the continued security of our website.
  • Should our practice experience a personal information breach, affected clients as well as the Information Regulator will be advised thereof as soon as practically possible.
  • You will be given access to your personal information only upon receipt of your express written request and/or consent (and/or that of your guardian, where applicable), to disclose the information concerned to a person nominated in the written document.
  • Drafting of reports, letters, etc, for third parties will only be done on receipt of your express written request and consent (and/or that of your guardian, where applicable).
  • Persons who wish to obtain more information regarding the Personal Information security protocols followed in our Practice can lodge a request with our Ms Naran through the Contact details on the first page of this agreement. Ms Naran will then decide whether to provide the requested information on a case-by-case basis;
  • If you are not satisfied with the way we deal with your personal information, you are entitled to lodge a complaint with the Information Regulator at the justice.gov.za website.