Forms & Policies

Integrative Holistic Counselling and Psychotherapy — Service Agreement & Informed Consent Form

The key in our mark stands for what this work is for — unlocking potential and reaching hidden depths in a space that is safe, confidential and yours.

Professional Accountability & Regulatory Compliance

Practitioner Credentialing: I, Regina Vaksman, affirm that I am a tertiary qualified, fully registered Practising Counsellor with the Psychotherapy and Counselling Federation of Australia (PACFA, Registration No: 33772).
Codes of Conduct: My practice is strictly governed by the PACFA Code of Ethics and the National Codes of Conduct for Healthcare Workers.
Legal Protections: Services are legally guided, informed, and compliant with the Privacy Act 1988 (Cth) and the Victorian Privacy and Data Protection Act 2014.
Insurance: I hold comprehensive Healthcare Professionals Civil Liability, Professional Indemnity, and Public Liability Insurance up to $20,000,000 per claim.

PACFA Certified Practising Counsellor badge

PACFA Certified Practising Counsellor · Reg. No 33772

View my PACFA membership certificate (PDF)

Confidentiality Framework & Records Management

All interactions with Integrative Holistic Counselling and Psychotherapy—including online telehealth, telephone, and face-to-face sessions—are strictly confidential. This applies to session notes, appointment schedules, clinical progress, and treatment outcomes. All digital records are protected inside an online encrypted secure vault, and physical paper documents are secured under lock and key in a filing cabinet.

Information discussed in sessions will not be shared with anyone without your written permission, except where I am legally or ethically obliged under the exceptions listed below.
Any request to release or exchange your information with a third party (such as your GP or another service) requires your specific written consent, which you may withdraw or alter at any time.
Confidential written records are maintained to reflect the issues and goals identified in sessions, and are kept securely for a minimum of seven years in accordance with professional record-keeping standards.
You may request access to your personal information held by the practice, in line with Australian privacy legislation.

Important Notice: Secure AI Note-Taking Technology

To ensure maximum clinical presence during your session, this practice utilizes secure, compliant artificial intelligence (AI) transcription technology to assist in drafting accurate documentation and session clinical summaries.

Audio processing is used solely to generate clinical records and summaries.
All data is processed through industry-standard encryption protocols that match or exceed required health privacy benchmarks.
No identifying personal data (such as names or specific identifiers) is stored or used to train third-party AI models.

Legal and Ethical Exceptions to Confidentiality

Information will not be disclosed to any third party without your express written consent, with the following legal exceptions:

Professional Clinical Supervision: Case details may be reviewed with a clinical supervisor for professional development purposes; however, all personal identifying details are completely stripped to preserve anonymity.
Safety & Risk of Harm: If there is evidence or explicit disclosure indicating an immediate risk of harm to yourself or others, I am legally and ethically obligated to report this information to the appropriate safety authorities.
Mandatory Child Protection Reporting: Under Victorian State Law, it is a criminal offense to fail to disclose any suspected or evident harm to a person under the age of 18, including sexual, physical, or psychological abuse.
Legal Subpoena: Your files may be subject to disclosure if subpoenaed by a court of law; note that counselors maintain the right to seek formal legal counsel prior to releasing records.

Digital Consent Form

This informed consent agreement follows the structure recommended by PACFA’s Good Practice Guideline on privacy, intake and consent in private practice. It is important that you are as fully informed as possible about counselling and the counselling process before commencing therapy. Please read the following carefully and do not hesitate to ask any questions.

1. Important facts about counselling and the process

Professional counselling is a safe and confidential collaboration between a qualified counsellor and client to promote mental health and well-being, enhance self-understanding, and resolve concerns. You are an active participant at every stage of the process.

Because every person is unique, outcomes of counselling can vary widely. No particular outcome can be promised or guaranteed; what I can assure you is my commitment to best practice with you in resolving your concerns.

Counselling may deal with issues and aspects of your life that can spark or trigger a wide range of feelings and reactions. Please keep me informed of any such experiences so I can support you.

To help you get the best out of the process, it helps to:

aim to attend every scheduled session;
be prepared to share your thoughts and feelings openly;
complete any out-of-session tasks we agree to; and
ask for clarification whenever you are unsure, and raise any doubts or concerns with me.

2. Important facts about your counsellor

Regina Vaksman holds a Master of Counselling (Deakin University) and a Bachelor of Arts in Community Development, and is a registered Practising Counsellor with the Psychotherapy and Counselling Federation of Australia (PACFA, Registration No: 33772). As a PACFA registrant, her practice is governed by the PACFA Code of Ethics and the National Codes of Conduct for Healthcare Workers.

Her approach is integrative and trauma-informed, grounded in person-centred values and drawing on the Gottman Method (Level 1 trained), CBT & ACT, Emotion-Focused and somatic interventions, and play-informed and expressive arts therapy, tailored to your individual needs.

Her training in these modalities was completed within her Master of Counselling and through ongoing professional development and clinical supervision. Consistent with PACFA's Scope of Practice for Registered Counsellors, she works within her training and competence and only delivers interventions she is suitably qualified and skilled to provide; a separate formal certification in each modality is not required for a tertiary-qualified, PACFA-registered counsellor.

3. Practicalities

Sessions: Standard sessions are 50 minutes, offered in person or via telehealth. For telehealth, we both ensure a confidential, uninterrupted space, do not record sessions, and aim for reliable connectivity.
Fees & cancellations: The fee structure, payment methods, and the 24-hour cancellation, late arrival and sobriety policies are set out on the Services & Pricing page and form part of this agreement.
In an emergency: This practice does not provide a crisis service. In an emergency, please call 000, contact your doctor or the emergency section of your local hospital, or call Lifeline on 13 11 14.
Privacy & confidentiality: Your personal information is handled in accordance with the Privacy Act 1988 (Cth) and the Victorian Privacy and Data Protection Act 2014, as described in the Confidentiality Framework above, subject only to the legal and ethical exceptions listed.
Records: Confidential written records are maintained to reflect the issues and goals identified in sessions and are kept securely in an encrypted digital vault or locked filing cabinet.
Supervision: As part of my ethical responsibility to reflect on my practice, I may discuss my work with a clinical supervisor; in such situations all content is de-identified.
AI note-taking: I consent to the use of secure AI-assisted note-taking as described in the notice above, unless I opt out in writing.

4. Acceptance by the client

I have read and understand this information, have had the opportunity to clarify my concerns, and agree to undertake counselling with Regina Vaksman. I understand that my engagement is voluntary and that I may conclude my sessions at any time.

You’ll be asked to sign this form digitally before your first session, and we will talk it through together at the start of that session so your consent is fully informed and freely given.