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LWWHC Consent Form

Living Without Worry Counselling
and Allied Health

Together, we can do more than we can do alone. Let’s bring our abilities and passions together to affect real change.

There are many ways to join us and support our mission. Contact us to find out more about counselling and NDIS support coordination, fundraising events, and ways that you can get our message to your friends and family.

If you need assistance completing the form phone us on 1300 889 609

LWWHC Consent Form

The purpose of this document is to explain important issues that relate to the counselling and supervisory services provided by Living Without Worry Health Clinic.

Confidentiality: As part of providing a counselling or supervision service we will be required to record and store information related to your circumstances. This is important in order for me to provide a quality service to you. You may request access to your information. We take confidentiality seriously and we will not disclose any information without your permission.

The exceptions to this: a) If required by Australian law or a court order b) Risks to you or others exist due to not disclosing the information.

Fees: The fee is required by cash or cards at the end of each session if you pay by yourself when you complete the following card section, otherwise we need payments when you book. If an organisation is funding sessions then an invoice will be sent after the session.

Registration with LWWHC: As part of our registration process, we collect the following information:

Personal Details

The purpose of this document is to explain important issues that relate to the counselling and supervisory services provided by Living Without Worry Health Clinic. Confidentiality: As part of providing a counselling or supervision service we will be required to record and store information related to your circumstances. This is important in order for me to provide a quality service to you. You may request access to your information. We take confidentiality seriously and we will not disclose any information without your permission. The exceptions to this: a) If required by Australian law or a court order b) Risks to you or others exist due to not disclosing the information.
The purpose of this document is to explain important issues that relate to the counselling and supervisory services provided by Living Without Worry Health Clinic. Confidentiality: As part of providing a counselling or supervision service we will be required to record and store information related to your circumstances. This is important in order for me to provide a quality service to you. You may request access to your information. We take confidentiality seriously and we will not disclose any information without your permission. The exceptions to this: a) If required by Australian law or a court order b) Risks to you or others exist due to not disclosing the information
Date/Month/Year

Payment Information unless pre-arranged otherwise

Cancellation Policy: If you are unable to attend, or you reschedule or cancel your appointment, we require a 48-business-hour notice. Failure to do this will incur the full cost of a session if cancelled within 24 business hours; or $100 if cancelled between 24-48 business hours. Please be aware that most funding does not offer the rebate for any cancellation fees.
Cancellation Policy: If you are unable to attend, or you reschedule or cancel your appointment, we require a 48-business-hour notice. Failure to do this will incur the full cost of a session if cancelled within 24 business hours; or $100 if cancelled between 24-48 business hours. Please be aware that most funding does not offer the rebate for any cancellation fees.
Health Questions - Have you (or are there any additional people on the premises who have) experienced symptoms of fever, cold or acute respiratory infection in the last 7 days?(Required)
Consent(Required)
I have read and understand this consent form. I agree the conditions of services provided by Living Without Worry Health Clinic. I consent for Living Without Worry Health Clinic (LWWHC) to collect, store and utilise this personal information for the purposes of providing services for/to me in accordance with the relevant privacy legislation and any other legal requirements that may apply.
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Stories of Growth

Discover the impact of our specialised services first hand as individuals share their transformative experiences in the testimonials section, offering insights into the positive outcomes achieved at Living Without Worry Health Clinic.

  • Living without Worry Clinic provides reliable and highly professional services. With their support, I am back to my social life and on the right track to my mental recovery journey. They support me to increase my NDIS funding, which allows me to have the most appropriate support in my life now.

    – Tommy W.

  • I am extremely happy with the service I have received from Living without Worry Clinic. They understand my situation and support needs with a gentle and warm-hearted approach. Under their professional support, I have dramatically increased my NDIS funding, which better meets my daily mental and physical support needs.

    – Jenny W.

  • I have received friendly, trustworthy and quality services from Living without Worry Clinic. They have improved my mental wellbeing and my life quality as a whole. I highly recommend this service.

    – Jacqueline E.