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Client Consent Form Terms & Conditions (Minor/Adult)

Please read the following terms and conditions and inform the practice if there is anything that you do not understand or do not consent to. By signing the attached Client Consent Form, you are signing that you have read and consent to the following:

CLIENT AGREEMENT

The Neurodiversity Centre (NDC) commits to providing the appropriate requested or clinically indicated services as agreed between both parties.  The NDC commits to working in the very best interest of the client, specifically honouring the HPCSA guidelines on ‘over-servicing’ and thus desisting from recommending or encouraging acceptance of any service that is clinically not indicated, unnecessary or inappropriate under the circumstances or which is not in accordance with, what is recognised by leaders in the field, as appropriate and recommended treatment protocols and procedures, without due regard to both the financial and health interests of the client.

PAYMENT OF SERVICES

  • Fees: We acknowledge that engaging professional psychological services represents both a significant commitment and financial investment. As a practice dependent upon professional fees for operation, implementation of our fee schedule ensures practice viability, appropriate compensation for specialized expertise, and maintenance of a professional therapeutic environment. Our operational expenses encompass facility costs, administrative infrastructure, ongoing professional development, and specialized consultative resources. This fee structure is essential to our continued capacity to provide evidence-based psychological services delivered with the highest standards of professional ethics and clinical excellence.
  • Time-based billing: All professional services provided by our clinical team are billed on a time-spent basis, reflecting the comprehensive nature of psychological care. This fee structure acknowledges that quality clinical work extends beyond direct client sessions to include all case-related activities necessary for effective treatment and ethical practice. Billable time encompasses direct client contact, consultation phone calls with healthcare colleagues or relevant third parties, clinical documentation, report writing, form completion, and any other professional activities undertaken specifically for the case. This comprehensive billing approach ensures that clinicians can dedicate appropriate attention to all aspects of client care without compromising quality, while maintaining the sustainability of our practice. These associated activities are essential components of professional psychological services and directly contribute to treatment efficacy and continuity of care.
  • Private paying clients: Payment for each appointment needs to be made on the day of the appointment. If an EFT payment is made, please provide proof of payment on the day of the appointment.
  • Increases: There will be annual increases in the practice fees for all services, and unless a formal quotation for a specific service is accepted in writing by both client and provider, these cost increases will apply to all clients (usually effective 1 January of each year).
  • Interest: 2% interest and administrative costs will be charged per month (after 60 days) for all overdue accounts. Additional costs incurred will be added to the client’s account if legal steps are taken by the practice.
  • Ultimate financial responsibility: The person signing financial consent is solely responsible for the payment of any and all accounts related to the services provided by the NDC for the benefit of the client, and if the client chooses to utilize any medical aid benefits, the person signing financial consent is still ultimately responsible specifically where the medical benefits are insufficient or disputed.
  • Conflict regarding financial responsibility: The NDC shall not be involved in any disputes, discussions, or conflicts related to custody arrangements (unless via a court-ordered care and contact process) or financial responsibilities between divorced/divorcing/separated parents/ parents and children (over 18) or legal guardians or any other related to financial responsibilities arising from services provided by the NDC. The NDC is released from any involvement in, or liability arising from, any disputes or conflicts, as per this paragraph.
  • Communication with NDC: In the event of any changes in financial responsibility or account payment arrangements, it is the client’s responsibility to communicate such changes, in writing, within 14 days, to the NDC. The client will be responsible for all accounts up until such notification of change has been received in writing by the NDC.
  • Additional billable services: All home/school observations, telephone, WhatsApp or email correspondence, and all letters/reports/documents/forms will be charged for as per the time utilized to complete.
  • Cancellation period: While the practice does have an SMS reminder system in place, this system may sometimes be faulty and should not be relied on as a means of reminding the client of the consultation. A 24-business hour notice period is required in the event that the client is unable to attend an appointment. For Monday appointments, a cancellation notice must be given by Friday, as weekends are not business days. Timely cancellations allow us to offer the slot to other clients or repurpose the time. Any appointments not kept without at least 24 business hours’ notice will be charged the full appointment fee (NDC rate).  This amount is not claimable from medical aid.
  • Halting of sessions: Further services may be halted if an account is not settled within the aforesaid period.

MEDICAL AID / MEDICAL INSURANCE (if applicable)

  • The NDC can submit claims directly to your medical aid.  In this event, the client remains responsible for ensuring all submitted claims are indeed received and processed by the medical aid. The client is required to cover any shortfall, rejection, or non-payment by my medical aid on the date of the outcome received. If the client chooses to utilize medical aid benefits, the client remains responsible for any and all accounts, specifically where the medical aid benefits are insufficient or disputed. 
  • The client may choose to settle the practice directly and claim from their medical scheme themselves. In this event, payment terms are the same as for private paying clients, and the session rate is required to be settled on the day of consultation.
  • This practice does not necessarily charge the rates that the client’s medical scheme / insurance may have decided upon.
  • All charges incurred are the client’s responsibility, regardless of the client’s medical coverage.
  • The NDC’s relationship is with the client, not with the medical aid/insurance company.
  • Please advise us in advance if there is an applicable Prescribed Medical Benefit (PMB) for psychotherapy services in place with the medical aid.
  • If a client qualifies for a Prescribed Minimum Benefit (PMB), an application can be submitted to the medical aid for reimbursement of future sessions (if approved). This process can only proceed after the Keyworker has conducted a comprehensive evaluation of the client.
  • It is the client’s responsibility to arrange contact with the medical aid to ascertain what funding is available, including how many PMB sessions are available, and not that of the NDC.
  • Not all services are covered benefits in all contracts; for example, services such as written reports, motivations, application forms, PMB applications, and telephonic consultations etc. are generally not covered under medical aid rules.
  • The NDC suggests and recommends assessment and intervention based on the need, not the client’s medical aid coverage or eligibility. 
  • Certain medical aid schemes frequently pay the member directly rather than the practice.  Should your medical aid indicate that it is going to reimburse you, we kindly request that you settle the practice directly on the day of consultation. Your administrator will let you know if this is the case with your specific claim.

PSYCHO-LEGAL / FORENSIC SERVICES

  • Certain practitioners in the NDC provide specific forensic services in the areas of assessment for neurodivergence, support in the workplace, and childcare and contact matters.
  • When consulting for therapeutic purposes (be it an assessment, individual, or other therapy), the role of the practitioner is therapeutic. This means that the practitioner cannot provide another psycho-legal role.  This is unethical and constitutes a dual role, and when a practitioner is seen to be siding with one disputing party, the therapeutic process and relationship with one or more family members can become contaminated.
  • For this reason, practitioners will not provide legal evidence of any kind, be it with regard to custody/divorce issues/relocation or any other matters.
  • Assessment reports are intended to assist parents, teachers, and caregivers in identifying appropriate treatment and are not for use in legal matters. 
  • Given this clear difference between a therapeutic role versus a psycho-legal role, should specific direction/assessment for psycho-legal purposes be required, the client should inform the practice at the outset.

CONSENT TO SERVICES

Obtaining parental consent for psychological services for minors upholds ethical standards and legal requirements. For divorced parents sharing legal custody, securing consent from both parties is essential to respect decision-making rights and prevent therapeutic disruptions. In South Africa, children under 14 require comprehensive parental consent, while those 14 and older can independently consent to certain psychological services under the Children’s Act, though parental involvement is still recommended. This age-based distinction balances respecting adolescents’ growing autonomy with ensuring appropriate guidance during crucial developmental stages.

For divorced parents sharing parental rights and responsibilities, securing consent from both parties is essential. This practice respects each parent’s decision-making rights, prevents therapeutic disruptions, and fosters collaborative support for the child’s treatment. Dual consent creates transparency, establishes clear expectations, and ultimately protects the child’s well-being while maintaining professional integrity in the therapeutic relationship.

CONSENT TO CONTACT OR INVOLVE OTHER SOURCES

The NDC works as a multidisciplinary team (MDT), meaning that there is collaboration between various practitioners in the organisation and in some cases, external MDT members. The client will be allocated a designated practitioner who will act as the Keyworker on the case, however, our team approach could result in the introduction of other practitioners for specific or additional assessment/support services as needed.  The practitioner will endeavour to gain the client’s consent before contacting external sources.

I hereby give consent that:

  • NDC practitioners may have access to the client’s file, administer or assist with an assessment, assist with report writing, provide additional services, or provide supervision.
  • NDC practitioners may contact the child’s teacher(s) and staff if he/she feel that it would be helpful to obtain information about the child’s functioning at school, as well as provide appropriate information and guidance to the school around how to best support the child.
  • NDC practitioners may contact relevant external sources to obtain additional collateral information about the client’s functioning or to provide appropriate information and guidance around how to best support the client.
  • The NDC may communicate with the client through electronic means of communication, such as email, SMS, WhatsApp, or virtual platforms etc. The NDC will take all reasonable precautions to ensure the confidentiality of such communication, however, there is always a risk inherent in such means of communication, whether due to unintended human error, or unauthorised external access.
  • In some exceptional circumstances, e.g. where clients live very far and where the NDC practitioner considers it appropriate, the use of virtual platforms / digital platforms may be incorporated into the intervention. The NDC practitioner will treat such consultations with the same level of confidentiality as any office-based consultation, and that confidentiality on the client’s side – that is, ensuring a private, secure environment – is the client’s own responsibility. All persons in the proximity of these meetings should be transparent and forthcoming about their attendance, despite not being in view, ensuring confidentiality and respect for the therapeutic process.
  • The NDC will process the client’s personal information as provided, for direct information provision and field-related marketing using electronic communication in respect of information and communications related to services. This personal data will be used solely for the purposes for which it was provided, and the client can at any time unsubscribe by sending an email to hello@neurodiversitycentre.co.za.

CONFIDENTIALITY

While confidentiality is a critical aspect of the therapeutic relationship, there are limits to confidentiality, including:

  • If the client threatens serious harm to self or others.
  • In situations where the client’s health or life is in danger, and the therapist is unable to get the client’s consent. This includes but is not limited to abuse, neglect, and exploitation. Discussion with the client will occur as soon as possible.
  • The practitioner is legally obligated to disclose information by an officer of the court.
  • The practitioner commits to, at all times, respect the assent of any minor child in any support or assessment services.

CONSENT TO PROCESS PERSONAL INFORMATION

  • The NDC will during the course of rendering services to the client, collect and have access to the client’s personal information, including information relating to the client’s race, gender, sex, pregnancy, marital status, national, ethnic, or social origin, colour, sexual orientation, age physical or mental health, well-being, disability, religion, conscience, belief, culture, language, identifying number, symbol, e-mail address, physical address, telephone number, location information, online identifier, and the client’s biometric information. A copy of the client’s medical records will be kept in the client’s practitioner’s file. All consultations and interactions are subject to electronic storage, and copies will be stored in a secure server as part of practice note-keeping for personal use of the practitioner.
  • The practice will collect and process this information for the purpose of rendering services to the client’s as well as processing claims with medical schemes or insurance funders. Administrative staff employed in the practice may be granted access to the client’s personal information contained in the client’s health record, including any clinical notes, in order to process claims to medical schemes, issuing of documentation, or any other administrative function required by the practice.
  • All personal information is stored in a safe, encrypted electronic environment. The practice makes use of GoodX, which is a cloud-based software program that stores information securely based on its internal protocols. The NDC staff are all bound by their statutory (HPCSA), legal (POPIA), and personal ethical responsibilities in the course of all of their clinical duties, and that they have access to all clinical notes secured on GoodX. Notes regarding the client’s or the client’s child’s intervention/support/assessment process will be stored on and processed by GoodX. The NDC staff will take every human precaution (in addition to legal and other precautionary measures) in the course of their day-to-day usage of the data and information stored on GoodX.
  • The client’s personal information will be accessed and processed by the client’s Medical Schemes and/or health insurer and GoodX will transmit that information as required to process any claims. The client’s personal information will only be utilized for the purpose of what it was collected for, and that the information will only be retained for as long as is necessary and required by law. The client has the right to view such information at any time. The POPIA Section 18 Practice Privacy Notification is available on request. The client has the right to review the Privacy Notification before signing this consent. This practice has implemented reasonable security measures to guard against the unauthorized disclosure of the client’s information, and the client may revoke this authorization in writing at any time.

RECORDING OF SESSIONS

Sessions (online or in-person) may not be recorded without the prior permission of all parties involved. The contents of sessions are for therapeutic purposes only and may not be misconstrued or misinterpreted to be anything more than stated.

AGREEMENT ENTERED INTO BETWEEN PRACTITIONER AND PERSON RESPONSIBLE FOR THE ACCOUNT

In accordance with legal requirements, the practitioner is granted permission to disclose any information about the responsible person and/or the client, including medical information and/or diagnosis or diagnostic codes, to relevant third parties (such as a funder, administrators, switching companies) for purposes of processing payment of accounts in respect of medical services rendered to the responsible person/the client,  as required by a specific act or statute, professional ethics or formal policy or directive applicable to the situation. The responsible person and/or client has been informed that, in certain circumstances, such as disclosure of ICD-10 codes, the exact consequence of disclosing such information is unknown to the practitioner and that information relating to these consequences must be obtained by the responsible person and/or client from the third party to whom the information is disclosed.

The practitioner may:

  • Make inquiries to confirm any information provided by the responsible person and/or client.
  • Seek information from any credit bureau when assessing the responsible person and/or client’s application for credit at any time during the client’s continuing indebtedness to the practitioner, including tracing or confirming his/her whereabouts.
  • Disclose the existence of the client’s account to any credit bureau, sharing both positive and negative payment information about such account.

The practitioner will be entitled to obtain and disclose the above information:

  • If the practitioner considers that it is necessary or may be of benefit to the responsible person and/or client.
  • Where the practitioner is under a legal obligation to do so.
  • Where it is in the practitioner’s own, or the public interest that he/she does so.

Collection costs/legal action:

  • Should the NDC institute legal action against the responsible person for recovery of any outstanding debts, the person responsible for payment is liable to pay all legal costs, including attorney and own client costs, collection fees, and tracing fees.

CLIENTS RESIDING OUTSIDE RSA

  • The NDC clinical staff are registered within their appropriate categories with the Health Professions Council of South Africa, the guiding statutory body for health and allied health professionals in South Africa.
  • The work and professional actions (of the relevant NDC professionals with whom the client may work) are bound by, and subject to, all of the legal, ethical, and professional standards of the HPCSA.
  • The NDC and the actions of its staff are governed by, and subject to, South African law;
  • Any legal matter will be pursued in the Magistrates Court in the Western Province of the Republic of South Africa. 
  • The client is obligated to pay the full amount for sessions, as per the international fee structure. This might take a few days, depending on the country. It is therefore kindly advised to make payments well in advance.
  • Any correspondence, reports, or findings from sessions with NDC staff may not be considered as adequate for entry into services in the country in which the client is resident. 
  • Should the client choose to pursue any legal action against the NDC or its staff, that:
  • The NDC and the actions of its staff are governed by, and subject to, South African law; and
  • The professionals of the NDC, whilst registered in the Republic of South Africa, are not registered in the client’s country of residence as either a Psychologist or Health Worker.

RESEARCH INVOLVEMENT

NDC is committed to supporting and conducting research in the course of the organization’s clinical practice. This research is to assist in developing local knowledge and evidence that can support people with neurodevelopmental differences. Anonymous clinical data may be collected from client records, and communication may be sent to the client regarding anonymous study participation to assist in developing South African healthcare science.

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