Consultation Services Informed Consent Form

Informed Consent Form

The purpose of this form is to share some important principles which guide the consultation process so that the client can make informed decisions to proceed in working together with the consultant based on accurate, informed expectations.

Naluri takes our service delivery and the confidentiality of our client’s personal information seriously in an effort to make sure that they are aligned with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards. Please read this carefully and feel free to ask any questions about what you have read or to have further clarification from our consultation team.

Informed consent is the clients’ full and active participation in making decisions that will affect them and their freedom of choice based on the information shared. It is a continuous process throughout the consultation relationship. The client has the right to refuse and/or withdraw from the consultation at any time without having to bear any consequences.

Psychological and Counselling Therapy Services

Therapy is not always easily described. Therapy is a process of personal exploration and may lead to major changes in one's life perspectives and decisions. It varies depending on the approaches used, the personalities of the consultant and the client and the particular problems brought to each session(s). Consultation calls for a very active effort from both parties in order for the therapy to be successful, the client will have to work on things talked about both during the session(s) and at home.

Therapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of our life, the client may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness and helplessness. On the other hand, therapy service has been shown to have benefits for people who go through it. Therapy can lead to better relationships, learning new ways to cope with or solve problems, developing new skills, a significant reduction in feelings of distress, changing unwanted behaviours, and improved self-esteem. There are no guarantees of what the client may experience; however, closure and reassurance will be implemented to ensure the session ends smoothly. Together we will work to achieve the
best possible results for you.

Dietitian Consultation Services

Dietitians do not provide medical advice nor prescribe treatment. Rather, he/she provides education to enhance clients’ knowledge on health-related aspects: food and nutrition, dietary supplements, and behaviours associated with eating.

Methods of nutritional evaluation or testing made available to the client are not intended to diagnose disease. Rather, these assessments are intended as a guide to enhance the client’s nutritional health and support the achievement of the client’s health goals. While nutritional support can be an important complement to medical care and mental health, nutrition counselling is not a substitute for diagnosis, treatment or care of disease by a medical provider.

Career Coaching Services

Career Coaching is a service provided to tackle both professional and personal development. Through coaching, issues affecting the client’s performance at the workplace or in life can be addressed, helping to arrive at improvements and career goals.

Executive coaching is defined as a supporting relationship formed between the Coach and Coachee which involves a series of one-on-one interactions. A wide variety of behavioural techniques and methods are used, such as observation, questioning, listening and feedback, to create a conversation that's rich in insight and learning. The goal of these conversations is to equip the Coachee with the knowledge and opportunities they need to develop and improve their professional performance and personal satisfaction hence becoming more effective in their roles.

Fitness Coaching Services

A fitness coach's goals are to help members develop a healthy lifestyle first and foremost, help empower members with the ability to maintain a healthy lifestyle, and, if requested by members, improve performance in a specific activity or sport.

Fitness coaches will be able to do two things, first is that they can have regular calls with the members to help coach members if they have a fitness programme either they acquired or the coaches themselves created for them. But this will depend on the plan set by both the member and the coach, as a few processes will need to happen if it is a regular thing (i.e., intake assessment, time commitment). Secondly, the coaches can have a
short follow-up or a one-off call to help members with form checking, and answering questions that the members might have regarding anything related to fitness, basic nutrition and how to live a healthy lifestyle.

Financial Coaching Services

A financial coaching session will involve a financial professional to help members gain financial knowledge and behaviour in order to achieve specific financial goals. The financial coaches will support the members in assessing their current financial situation, identifying their financial goals and challenges, and developing a plan to reach those goals. The members will be educated in the basics of personal finance, being guided and encouraged through the financial planning process and decision making based on the goals.

The financial coaching will focus more on the behavioural and emotional aspects of money management, rather than just the technical aspects. The goal is to help members develop a healthy relationship with money and make sustainable financial decisions that align with their values and goals.

Medical Consultation Services

A Medical consultation means conferring with and seeking assistance from a physician or other licensed healthcare professional for assessment and therapeutic interventions or other services that will benefit the client.

It is a procedure whereby a healthcare provider reviews a patient's medical history, examines the patient and makes recommendations as to care and treatment. However, the COVID-19 pandemic has dramatically changed how patient care is delivered in healthcare practices, converting in-person visits to telemedicine visits. Hence, teleconsultations are a safe and effective way to assess and guide the patient's diagnosis and treatment remotely, where interactions happen between a clinician and a patient for the purpose of providing diagnostic or therapeutic advice through electronic means.

Confidentiality

Information revealed by the client during consultation session(s) will be kept strictly confidential and will not be revealed to any other person or agency without the client’s written permission, with the following exceptions:

Duty to Warn. If an individual intends to take harmful, dangerous, or criminal action against another human being or against himself or herself, it is our duty to warn appropriate individuals or agencies of such intentions. A consultant is required to breach confidentiality if the client poses an imminent threat to either themselves, the consultant, or a third party. Also, any actual or suspected acts of child, elder or disabled person abuse (including physical abuse, sexual abuse, unlawful sexual intercourse, neglect, emotional and psychological abuse) will need to be reported to the appropriate agencies by the consultants. The necessary information must be divulged to someone who is capable of taking action to reduce the threat.
Court Subpoenas and administrative proceedings. When lawyers believe that a client’s consultant may have valuable information for their case, they will subpoena her/his notes, records, and in some instances, even the therapist themselves. In general, once a subpoena is served on a consultant, it must be obeyed, or the consultant can be charged with contempt.
Consultation. Information about the client may be discussed in confidence without revealing the client's identity, with other consultation professionals and/or supervisors for the purpose of consultation and providing the clients with the best possible service.

Disclose of Personal Information

Personal information includes psychotherapy notes, case notes, assessments, records, summaries and reports that are related to the client during the consultation session(s). Naluri as an organization including consultants and all other staff are accountable to make sure that the client's personal information is kept confidential according to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards, and/or other relevant professional ethical guidelines and code of conduct.

In any circumstances that the client's personal information is required by the client, any person, agency or organisation, the request should be supported with valid and relevant reasoning. The consultant has the right to decide what information can be disclosed depending on the reasons. Prior written informed consent must be obtained from the client before disclosing it to other parties.

For clients under the EAP programme, the employer will receive only aggregated data and a general progress summary of the EAP programme, nothing specific about any individuals will be disclosed unless there is a risk to self, others or by others.

Client's Rights

In consultation, the client may ask questions or clarify anything. The consultant is willing to discuss how and why certain decisions were made.
The client may ask the consultant to try something that the client thinks may be helpful. The consultant is willing to look for alternatives that may work better.
The client may cease to continue the consultation anytime, without any impediment and may return
to it anytime. A termination session(s) is highly recommended to have a proper closure for both sides. This applies as well whenever the client would like to change their attending consultant.
The client may request to review his/her progress during the consultation session(s). The consultant may provide a summary on a case-by-case basis which is beneficial to encourage client improvement
in the session(s).
Right to confidentiality: Within limits provided for by law, all records and information acquired by the consultants shall be kept strictly confidential in accordance with the principles of a
doctor-patient relationship. All information will not be shared or revealed to any person, agency, or organisation without the prior written consent of the client.
The client can raise any concerns and speak with the consultant immediately about any concerns provided that the consultant is likewise available to discuss matters with the client.
The client’s human rights and dignity are to be respected at all times. This is also included in the client's rights to be self-governing throughout the process.

Consultants' Rights and Responsibilities

Our consultants have the rights and/or responsibilities to;

Expect you to attend sessions regularly, be punctual and pay for services when rendered unless previous arrangements are made, i.e., you are under your company’s sponsorship or social service agency.
Expect you to show an acceptable level of commitment throughout the consultation process, i.e., follow through on agreed-upon homework assignments or exercises, take the initiative to schedule your next session and inform us of changes in availability in a timely manner.
Expect you to turn on your video when attending a virtual session in a conducive environment. We believe this will help greatly in building rapport and effective communication.
Expect you to communicate with the consultant if there are any dissatisfactions with the approach taken by the consultant.
Dismiss the client from the service with valid reasoning, i.e. sexually harassed, threatened, or abused verbally by the client.
The client’s human rights and dignity are to be respected at all times. This also includes the consultant’s right to be respected, i.e. to communicate respectfully.
In the case of harassment and high dependency on the consultant and therapeutic process/consultation service, make a necessary report to management while maintaining the client’s confidentiality.
Be protected and investigated by the Naluri Consultation Team if there are any complaints made by the clients.
Commit and act in the best interest of the client(s) and maintain a professional relationship.
Maintain a reasonable level of current knowledge and skills in our therapeutic practice.
Be in good standing with their professional association(s).
Practice within their credentials and limitations only (e.g., practice within qualified areas of expertise and training).

Minors (Clients under 18)

If you are under 18 years of age, please be aware that:

You will need to complete a parental consent form as proof that the parents acknowledged and allowed the client to proceed with the consultation session(s).
That the law may provide the client's parents with the right to examine treatment records.
It is our policy to request an agreement from parents that parents can have access to relevant, general and consented information only. This information will be reported in the treatment progress report, consented to by the client.
If the consultant feels there is a high risk that the client will seriously harm himself/herself or someone else, more details will be provided as seen fit.
In cases of possible harm, we will notify the parents of the concerned and provide them with a summary of the treatment when it is complete. Duty to Warn policy will be applied.
Before providing any information, the consultant will discuss the matter with the client, if possible, and do their best to handle any objections the client may have with what is prepared to be discussed.

Cancellation, Rescheduling, and No-Show Policies

If you need to reschedule or cancel your session once it has been confirmed, please email consultation@naluri.life or call us at +603-27229283 with at least 24 hours' notice.

Without such notice, you will forfeit 100% of the session fee, or the amount will be charged to your company if you are under an EAP programme. If prior notice was given less than 24 hours, you will forfeit 50% of the session fee instead.

In that same spirit, Naluri reserves the right to modify or cancel any session at least 24 hours in advance should a regrettable, unforeseen circumstance arise. You will be informed of any such change via phone or email. In the unlikely event that a psychologist, counsellor or coach does not provide notice, the next session will be provided free of charge at an alternate date and time agreed upon or refunded in accordance with
the refund policy.

Naluri and the consultant reserve the right to review and terminate the services if the client has at least 3 consecutive no-shows and last-minute rescheduling/cancellations without any valid reason. Special exceptions or accommodations may be extended regarding this policy due to extenuating circumstances but are subject to Naluri’s discretion.

Acknowledgement

With the extension of consultation services provided by Naluri via online platforms, by scheduling an appointment, you are accepting full responsibility for any information that is released during the session(s) and will not hold Naluri accountable for any information that may be disclosed on your end. This may be and is not limited to having the session(s) in the same room as your spouse, family members, or any individual
present who may be listening in the background.

By agreeing to provide your personal details to Naluri Hidup Sdn Bhd to book your appointment and for record-keeping purposes, you also give Naluri permission to contact the emergency contact person should Naluri perceive the need to do so in case of emergency, crisis or any relevant circumstances.

By providing your personal details, you also acknowledge that you have read and agree to the clauses stated above.

Note: if you have any concerns regarding the consent form, do note them down and feel free to discuss them with your consultant during your first session.

Naluri Consultation Services Informed Consent

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