Please note - this question is included for assessment purposes only. LIL does not provide NDIS funded services.

Please note - Life In Loss is a brief support service for individuals experiencing sudden or impactful loss, trauma or change.  If you require further information to know if the service is right for you, please call for a free 10-minute consultation.  

Please see CANCELLATION & THIRD-PARTY DOCUMENTATION POLICY

As part of providing a professional Social Work suppoort service to you, our Social Worker will need to collect and record personal information from you that is relevant to your current situation.  This information will form a necessary part of our assessment, intervention (counselling / support), and ongoing planning processes. 

ACCESS:  You may access the material recorded in your file upon request, subject to the exception in National Privacy Principle 6. 

CONFIDENTIALITY:  All personal information gathered by the Social Worker during the provision of Social Work based counselling and support services will remain confidential and secure, except when - 

• it is subpoenaed by a Court,

• disclosure of your information is required to promote safety for you and / or another person at immediate risk of harm,

• you have explicitly provided prior approval to discuss the material with another person, i.e. a spouse, parent or employer. 

Please refer to LIL Privacy Policy for more information. 

At Life In Loss, we understand that life can be unpredictable, and that appointments may need to be rescheduled at times. However, to ensure we can support all clients effectively, we kindly ask for advance notice if you need to cancel or reschedule your session.

• More than 48 hours notice: No fee will be charged.

• Less than 48 hours notice: 50% of the session fee will be charged.

• Less than 24 hours notice or no-show: The full session fee will be charged.

This policy allows us to offer timely support to other client who may be waiting for an appointment. If you have any questions or concerns, please don't hesitate to discuss them with us.

Clinical Notes & Third-Party Documentation Policy

Life In Loss / I (Alisa Ranson) do not provide clinical notes or documentation for third-party claims (e.g. insurance, legal, workplace requests) due to the nature of my practice. If you require such documentation, I recommend consulting with a registered psychologist.

By signing below, you acknowledge and accept this policy. Please discuss any concerns before proceeding.

I have completed the information provided within this form to the best of my knowledge.  I understand that, with my permission, you may contact the service provider/s listed in the form, if considered necessary, and at your discretion. I have read, or had this form verbally explained to me.  I understand this Consent Statement, and I agree to these conditions for the services provided to me by Life In Loss. I accept the Cancellation Policy as provided to me within this document.

You can discuss this Intake & Consent Form with Life In Loss if you have any questions or concerns, or do not fully understand the content. 

For more information, please do not hesitate to contact:

info@lifeinloss.com.au

0452 011 924