Alite Mind Client Informed Consent Form

"*" indicates required fields

As part of the provision of service to you, including but not limited to counselling, coaching, mindfulness therapies and classes, ALITE MIND needs to collect and record personal information from you. In accordance with relevant privacy and confidentiality legislation, the information collected may include (but may not be limited to) your name, contact details, medical history, employment status and other relevant information as appropriate.

The collection of this information is a necessary part of your participation in ALITE MIND COUNSELLING / COACHING. Your informed consent must be given prior to commencement of services.

Privacy and Confidentiality

Your personal information is gathered as part of the service you are engaging in. Information is securely stored and is retained in order to document what occurs during coaching sessions. This helps the Practitioner to provide a tailored service specific to your needs.

Limits to Confidentiality

All personal information gathered by ALITE MIND during the provision of services remains confidential except when:

1. It is subpoenaed by a court; or

2. Failure to disclose the information would, in the reasonable belief of ALITE MIND place you or another person at serious risk to life, health or safety; or

3. Your prior approval has been obtained to

a) provide a written report to another professional or agency;
b) discuss the material with another person;
c) disclose the information in another way; or

4. You would reasonably expect your personal information to be disclosed to another professional or agency (e.g. your GP) and disclosure of your personal information to that third party is for a purpose which is directly related to the primary purpose for which your personal information was collected; or

5. Disclosure is otherwise required or authorised by law.

Consequence of Not Providing Personal Information

If you do not wish for your personal information to be collected in a way anticipated by this consent form, ALITE MIND may not be able to provide the COUNSELLING / COACHING service to you.

Consent

Client name*

If client is under 18 years of age:

Client Name

Parent/Guardian’s Name

Is the referring parent aware of any Orders (Parenting or other) that are in place? If so, please explain in the space provided below:

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Kind Words

Michelle Boyd

August 16, 2024

My favourite way to spend a Monday night, is to visit the Alite Mind studio for Group Meditation Natalie has created a warm and cosy space to unload your worries & stresses of the day. Stepping into the room feels like being enveloped in a giant hug. Her presence is very calming and I leave feeling refreshed and have clarity of mind. I thoroughly enjoy the sessions

Ildi

August 13, 2024

I have felt consistently supported and safe with the compassionate, authentic, gentle care provided by Natalie, at a truly difficult and challenging time :)

Nicole Laughton

August 13, 2024

I highly recommend Natalie at Alite Mind she supported me through a very high stressful time in my life. I felt safe, supported and understood all the way through our sessions. I took the opportunity to become a member to her meditations and they too are amazing, her voice is so calm and soothing easy to follow. Natalie is very professional, kind and compassionate. Thank you for all you have done to support me in my time of need.

Deb Harvey

July 16, 2024

I love my Tuesday morning meditations at Alite Mind. The atmosphere is so relaxing and welcoming and the session is just lovely, like a warm hug! I always leave feeling rejuvenated and relaxed. Thank you!

Rach Jenkins

June 10, 2024

Nat is amazing very supportive and helpful to learn more about meditation The group is a Wonderful safe and comfort zone

Sean Lappin

May 26, 2024

Natalie’s journey began as a personal one, embodying her practice and then working with her colleagues within her own business to assist them to realise the many benefits Natalie knows are associated with mindfulness approaches. She brings this experience and integrity to establishing Alite Mind. An organisation that she has established to help others on their mindfulness journeys.

Alite Mind Client Informed Consent Form