Thank you for choosing Heart Wired Therapy. This is a space to pause, reflect, and reconnect with yourself. To help me understand how best to support you, please complete the information below before our first session. There are no right or wrong answers, so share only what you feel comfortable sharing, and we can explore anything further together in session.
Informed Consent & Agreement for Counselling
It is important that you feel as informed as possible about counselling before we begin working together. Please read the following carefully and do not hesitate to ask me any questions, and we can also talk it through in our first session, and your consent should feel freely and comfortably given.
Some important things about counselling
Counselling is a safe, confidential and collaborative relationship in which you are an active participant at every stage. People come to counselling for many different reasons, and I look forward to understanding yours and navigating the journey alongside you.
Because each of us is shaped by our own history, perceptions and circumstances, the outcomes of counselling vary from person to person. For this reason I cannot promise any particular outcome, but I can assure you of my commitment to working with care, integrity and best practice as we explore your concerns.
By its nature, counselling can touch on difficult experiences and may stir a wide range of feelings. Please keep me informed if this happens for you, so I can support you well. To help you get the most from our work, it helps to attend sessions where you can, share openly, follow through on anything we agree to between sessions, and ask questions whenever something is unclear.
My professional background & approach
Marija Rilkovska holds a Graduate Diploma in Counselling and is a Registered Member of the Australian Counselling Association (ACA), registration no. R85287. As an ACA member I am bound by the ACA Code of Ethics and Practice and the NSW Code of Conduct for non-registered health practitioners, and I hold professional indemnity insurance.
I see the relationship between us as central to the work. I aim to offer a respectful, non-judgemental space in which your experience is understood and valued. My approach is integrative and trauma-informed and draws on relational, attachment, somatic / nervous-system and developmental understandings, with a strong emphasis on translating insight into practical, real-world change. At its heart, my work is about helping you move from simply surviving toward greater connection with yourself and others.
Some practicalities
Hours: 9am to 5pm, Friday, Saturday and Sunday (AEST).
Session length & frequency: Sessions are typically 60 minutes. Frequency depends on you and what you are working through; I usually suggest an initial commitment of around six sessions, weekly or fortnightly, which we then review together.
Telehealth: Sessions are offered via secure telehealth only (video or phone). See the telehealth section below.
Fees & rebates: The fee for an individual session is $120, and for couples $180, and this must be paid via direct bank transfer to account number 4586 3387, BSB 670 864, at the conclusion of each session. Counselling sessions are generally not claimable through Medicare; some private health funds offer rebates for ACA-registered counsellors, so please check directly with your fund.
Cancellations: Please give me at least 48 hours’ notice if you cannot attend. Late cancellations made less than 48 hours and missed appointments may incur a 50% non-attendance fee.
In an emergency
I do not provide a crisis or after-hours service. If you are in immediate danger or need urgent support, please contact:
Emergency services on 000 , or the emergency department of your nearest hospital
Lifeline 13 11 14 · Suicide Call Back Service 1300 659 467 · 13YARN 13 92 76
NSW Mental Health Line 1800 011 511 · 1800RESPECT (domestic & family violence) 1800 737 732
Telehealth sessions
Where we meet by video or phone, sessions are provided through a secure, encrypted platform, Teams. All initial appointments will be conducted via Teams, and a link will be sent to you 24 hours prior to the session. For these sessions we both agree to:
find a private, quiet and uninterrupted space, and aim for a stable internet or phone connection
not record the session (audio, video or screenshots) unless we have discussed and agreed to this in writing beforehand
agree a plan for technical disruptions: if we are cut off, I will attempt to reconnect and, if needed, continue by phone
At the start of a telehealth session I may confirm your current physical location and your emergency contact, so that I can respond appropriately if a safety concern arises. You may withdraw your consent to telehealth at any time and request in-person sessions where available.
Privacy
Your personal and health information is handled in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles, and the Health Records and Information Privacy Act 2002 (NSW). My full Privacy Policy is available on request and forms part of this agreement.
Confidentiality & its limits
What you share with me is confidential and will not be disclosed without your written consent, except where I am legally or ethically obliged to act. These limited circumstances are:
where there is a serious and imminent risk to your safety, or to the safety of another person
where a child or young person is at risk of significant harm, which I am required to report1
where disclosure is required by law (for example, a court order or subpoena).
Wherever possible I will discuss any need to share information with you first, involve you in the process, and limit what is disclosed to only what is necessary.
Records & supervision
I keep confidential, secure written records of our work. In NSW these are held for at least seven years from our last contact, or, if you were under 18 at our last contact, until you turn 25. You may request access to, or correction of, your information in line with privacy law.
As part of ethical practice, I reflect on my work in regular professional supervision. Any material discussed there is de-identified so that you cannot be recognised.
AI-assisted note-taking
To help me keep accurate records and stay fully present with you in session, I sometimes use AI-assisted note-taking or transcription tools. This may include note-taking features built into the secure telehealth platform we use (for example, Microsoft Teams or Zoom), which are encrypted and password-protected. These tools only ever help me draft my notes; I always review and confirm them myself for accuracy, and AI never replaces my professional judgement or the human heart of our work together.
Any information handled this way is protected in line with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. Using these tools is entirely your choice: you can decline, or withdraw your consent at any time, and this will not affect the care you receive or our relationship in any way. Please feel free to ask me anything about how these tools work.
Your agreement
I have read and understood this information, have had the opportunity to ask questions, and agree to engage in counselling with Heart Wired Therapy. I understand that my participation is voluntary and that I may pause or end counselling at any time. *
The counsellor’s name and countersignature are completed by Heart Wired Therapy once your form is received.
