Client Consent & Service Agreement

1. NATURE OF SERVICES

​1.1 Service Description
SURVIVR National provides transformational support services combining evidence-based therapeutic frameworks with lived experience methodologies. Our services include individual therapy sessions, group programs, intensive workshops, and educational resources designed to support individuals in shifting from victim mentality to survivor empowerment.

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1.2 Not Medical Practice
SURVIVR National is NOT a medical practice, psychiatric facility, or crisis intervention service. Our services utilize unique lived experience techniques, trauma-informed approaches, and empowerment frameworks that may differ from traditional therapeutic modalities. The Provider is a qualified social work professional with lived experience of trauma recovery, addiction recovery, and personal transformation.

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1.3 Suitability Acknowledgment
You acknowledge that SURVIVR National's approach may not be suitable for all individuals. The intensive, direct, and challenging nature of our work requires emotional stability, readiness for change, and the capacity to engage with difficult material. You have the right to discontinue services at any time if you determine our approach is not suitable for your needs, with no obligation to continue.

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2. VOLUNTARY PARTICIPATION

​2.1 Voluntary Nature
You acknowledge that your participation in SURVIVR National services is entirely VOLUNTARY. You are under no obligation to commence, continue, or complete any program or service. You may withdraw your participation at any time without penalty, prejudice, or requirement to provide explanation.

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2.2 Right to Decline
You have the right to decline or refuse any aspect of the services offered, including specific exercises, discussions, or methodologies, without jeopardizing your overall participation in the program.

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​3. MEDICAL AND MENTAL HEALTH CLEARANCE

​3.1 Medical Consultation Requirement

By signing this Agreement, you affirm and warrant that:

a) You have consulted with your primary medical practitioner and/or mental health professional regarding your intention to participate in SURVIVR National services;

b) You have disclosed to your medical practitioner the nature, intensity, and approach of SURVIVR National services;

c) Your medical practitioner has been informed of the potentially challenging, emotionally activating, and intensive nature of the program;

d) You have been medically cleared by a qualified healthcare professional to participate in SURVIVR National services with no known adverse effects to your physical or mental health; and

e) You have disclosed to SURVIVR National any and all relevant medical conditions, mental health diagnoses, current medications, and treatment you are receiving that may impact your participation.

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3.2 Ongoing Medical Support
You acknowledge and agree that participation in SURVIVR National services does NOT replace ongoing medical care, psychiatric treatment, medication management, or other necessary healthcare services. You agree to maintain appropriate medical and mental health support throughout your participation in our services.​​

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3.3 Duty to Inform

You agree to immediately inform SURVIVR National of any changes to your medical status, mental health condition, medications, or other treatments that may impact your ability to safely participate in services.
 

4. MENTAL HEALTH STABILITY DECLARATION

​4.1 Current Mental State

By signing this Agreement, you affirm and warrant that:

a) You are currently in a stable mental state sufficient to participate in intensive transformational work;

b) You are not currently experiencing active suicidal ideation with intent or plan;

c) You are not currently experiencing active psychosis, severe dissociation, or other symptoms that would impair your ability to engage safely in services;

d) You are not currently in a state of acute mental health crisis requiring immediate psychiatric intervention;

e) You have the emotional capacity to engage with potentially distressing material, including discussions of trauma, adversity, and challenging experiences; and

f) You possess adequate coping skills and support systems to manage emotional activation that may arise during and between sessions.

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4.2 Deterioration of Mental State

You agree to immediately notify SURVIVR National if your mental state deteriorates, if you experience increased suicidal ideation, if you begin experiencing symptoms that impair your functioning, or if you enter a state of crisis. You understand that continuation of services will be reassessed based on your current clinical presentation and safety needs.​​
 

5. INFORMED CONSENT TO SERVICES

​5.1 Understanding of Approach

You acknowledge that you have been informed of and understand:

a) The nature, goals, techniques, and procedures of SURVIVR National services;

b) The intensive, challenging, and direct approach utilized, including confrontation of victim mentality, cognitive restructuring, and narrative transformation;

c) The integration of lived experience methodology with clinical frameworks;

d) The requirement for active participation, between-session work, and personal responsibility in the transformation process;

e) The potential benefits of services, including increased resilience, empowerment, post-traumatic growth, and identity transformation; and

f) The limitations of services, including that outcomes cannot be guaranteed and that transformation requires sustained personal effort beyond the program duration.

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​5.2 Acknowledgment of Terms and Conditions

You affirm that you have:

a) Read and fully understood all Terms and Conditions of Service;

b) Reviewed the detailed Service Agreement outlining program structure, expectations, and requirements;

c) Understood the professional scope of service and its boundaries;

d) Been provided adequate opportunity to ask questions and receive clarification regarding any aspect of services; and

e) Received satisfactory answers to all questions prior to signing this Agreement.

6. RISKS AND POTENTIAL ADVERSE EFFECTS

​6.1 Acknowledged Risks

You acknowledge and accept that participation in SURVIVR National services involves inherent risks, including but not limited to:

a) Emotional Distress: Discussion of traumatic experiences, challenging of long-held beliefs, and confrontation of victim mentality may cause temporary or sustained emotional distress, anxiety, anger, sadness, or other difficult emotions;

b) Trauma Activation: Exploration of past trauma may activate trauma responses, including flashbacks, nightmares, hypervigilance, dissociation, or increased symptoms of post-traumatic stress;

c) Relationship Strain: Personal transformation may create tension in existing relationships as you change patterns, set boundaries, or shift dynamics with family, friends, or partners;

d) Increased Awareness of Pain: Becoming more aware of past harm, current patterns, or limiting beliefs may temporarily increase psychological discomfort before improvement occurs;

e) Anxiety and Discomfort: Stepping outside your comfort zone, facing avoided situations, and challenging yourself may cause significant anxiety and discomfort;

f) Potential for Crisis: In rare cases, engagement with difficult material may precipitate a mental health crisis requiring additional intervention;

g) Substance Use Relapse: For individuals in recovery, exploration of trauma and emotions may increase vulnerability to relapse if adequate support structures are not in place; and

h) No Guaranteed Outcomes: Despite best efforts, there is no guarantee that services will result in desired changes, symptom reduction, or personal transformation.
 

6. RISKS AND POTENTIAL ADVERSE EFFECTS

​6.1 Acknowledged Risks

You acknowledge and accept that participation in SURVIVR National services involves inherent risks, including but not limited to:

a) Emotional Distress: Discussion of traumatic experiences, challenging of long-held beliefs, and confrontation of victim mentality may cause temporary or sustained emotional distress, anxiety, anger, sadness, or other difficult emotions;

b) Trauma Activation: Exploration of past trauma may activate trauma responses, including flashbacks, nightmares, hypervigilance, dissociation, or increased symptoms of post-traumatic stress;

c) Relationship Strain: Personal transformation may create tension in existing relationships as you change patterns, set boundaries, or shift dynamics with family, friends, or partners;

d) Increased Awareness of Pain: Becoming more aware of past harm, current patterns, or limiting beliefs may temporarily increase psychological discomfort before improvement occurs;

e) Anxiety and Discomfort: Stepping outside your comfort zone, facing avoided situations, and challenging yourself may cause significant anxiety and discomfort;

f) Potential for Crisis: In rare cases, engagement with difficult material may precipitate a mental health crisis requiring additional intervention;

g) Substance Use Relapse: For individuals in recovery, exploration of trauma and emotions may increase vulnerability to relapse if adequate support structures are not in place; and

h) No Guaranteed Outcomes: Despite best efforts, there is no guarantee that services will result in desired changes, symptom reduction, or personal transformation.

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​6.2 Consent to Risk

You CONSENT to engage in SURVIVR National services with full knowledge and acceptance of these risks. You acknowledge that you have been advised of these risks and have had the opportunity to discuss concerns with the Provider.​

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​6.3 Trauma Response Acknowledgment

You specifically acknowledge and consent that:

a) Content discussed in sessions, exercises assigned, and frameworks presented MAY ACTIVATE TRAUMA RESPONSES;

b) This activation, while potentially distressing, may be part of the therapeutic process of trauma integration and post-traumatic growth;

c) The Provider will work to manage activation within your window of tolerance but cannot eliminate all risk of trauma response;

d) You have adequate coping skills, support systems, and professional resources to manage trauma responses that may arise; and

e) You will communicate with the Provider regarding your capacity and tolerance levels during sessions.

7. NOT A CRISIS SERVICE

​7.1 Crisis Intervention Limitation

You acknowledge and understand that:

a) SURVIVR National is NOT a crisis intervention service;

b) SURVIVR National services are NOT designed to address acute mental health emergencies;

c) SURVIVR National does NOT provide 24-hour crisis support or emergency response services;

d) Between-session communication is limited to brief check-ins and scheduling matters, not crisis management; and

e) The Provider may not be immediately available to respond to urgent communications.
 

7. NOT A CRISIS SERVICE

​7.1 Crisis Intervention Limitation

You acknowledge and understand that:

a) SURVIVR National is NOT a crisis intervention service;

b) SURVIVR National services are NOT designed to address acute mental health emergencies;

c) SURVIVR National does NOT provide 24-hour crisis support or emergency response services;

d) Between-session communication is limited to brief check-ins and scheduling matters, not crisis management; and

e) The Provider may not be immediately available to respond to urgent communications.

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​7.2 Crisis Protocol

You acknowledge that if you are experiencing a MENTAL HEALTH CRISIS, including but not limited to:

• Active suicidal ideation with intent or plan

• Intent or plan to harm another person

• Severe dissociation or psychotic symptoms

• Inability to care for yourself or ensure your safety

• Acute substance intoxication or overdose

• Severe panic or anxiety that you cannot manage
   

You agree to IMMEDIATELY contact:

• Emergency Services: 000 (Australia)

• Suicide Prevention Lifeline: 13 11 14 (24/7)

• Lifeline Crisis Text: 0477 13 11 14 (24/7)

• Mental Health Crisis Line: 1800 011 511 (24/7)

• Your local hospital emergency department

• Your treating psychiatrist or mental health professional

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​7.3 Crisis Acknowledgment

By signing this Agreement, you confirm that you understand SURVIVR National is not equipped to provide crisis intervention and that you will utilize appropriate emergency services if a crisis arises. You agree not to rely on SURVIVR National for crisis support.
 

8. COMPLETE WAIVER OF LIABILITY

​8.1 Full Release and Waiver

To the fullest extent permitted by law, you RELEASE, WAIVE, DISCHARGE, and HOLD HARMLESS SURVIVR National, its owner(s), practitioners, employees, agents, contractors, affiliates, and any associated parties (collectively, the "Released Parties") from any and all liability, claims, demands, actions, causes of action, costs, and expenses (including legal fees) arising from or related to:

a) Your participation in SURVIVR National services;

b) Any actions, decisions, or behaviours you undertake prior to, during, or after engagement with SURVIVR National services;

c) Any adverse mental health outcomes, emotional distress, or psychological harm arising from participation in services;

d) Any crisis, emergency, self-harm, suicide attempt, or death that occurs prior to, during, or after participation in services;

e) Any relapse to substance use, behavioural addiction, or other harmful patterns;

f) Any deterioration in mental health, relationships, employment, or other life domains;

g) Any decisions made based on discussions, guidance, or frameworks provided during services;

h) Any harm to yourself or others arising from your actions or omissions;

i) Any failure of services to produce desired outcomes or results; and

j) Any other claim whatsoever arising from or related to your participation in SURVIVR National services, regardless of the legal theory upon which such claim is based.

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​8.2 Assumption of Risk

You ASSUME ALL RISKS associated with participation in SURVIVR National services, including all risks outlined in Section 6 of this Agreement and any other foreseeable or unforeseeable risks. You acknowledge that you are participating with full knowledge of these risks and accept complete personal responsibility for any consequences.

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​8.3 No Liability for Outcomes

You acknowledge and agree that:

a) SURVIVR National takes NO LIABILITY for any outcomes, whether positive or negative, resulting from engagement with services;

b) The Provider makes no guarantees, warranties, or representations regarding the results, effectiveness, or outcomes of services;

c) Personal transformation is dependent on multiple factors including your effort, commitment, support systems, and circumstances beyond the Provider's control;

d) The Provider cannot and does not guarantee symptom reduction, improved functioning, relationship improvement, or any specific outcome; and

e) You accept full responsibility for your own progress, outcomes, and wellbeing.

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​8.4 Actions Prior to Services

You acknowledge that SURVIVR National is not responsible or liable for any actions, decisions, mental health conditions, crises, or circumstances that existed or occurred PRIOR TO your engagement with services, including but not limited to pre-existing trauma, mental health conditions, substance use patterns, relationship difficulties, or any other pre-existing conditions.

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8.5 Actions During Services

You acknowledge that SURVIVR National is not responsible or liable for any actions or decisions you make DURING your participation in services, including but not limited to:

a) Decisions to engage or not engage in suggested practices or exercises;

b) Decisions regarding relationships, employment, housing, or other life circumstances;

c) Use of substances or engagement in harmful behaviours;

d) Interactions with others or conflicts that arise;

e) Self-harm or harm to others; or

f) Any other choices, actions, or omissions you undertake during the period of service engagement.

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8.6 Actions After Services

You acknowledge that SURVIVR National is not responsible or liable for any actions, decisions, outcomes, or circumstances that occur AFTER conclusion or termination of services, including but not limited to:

a) Maintenance or loss of gains achieved during services;

b) Relapse to previous patterns or behaviours;

c) New challenges, crises, or difficulties that arise;

d) Decisions to seek or not seek additional support; or

e) Any other post-service outcomes, circumstances, or events.

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​8.7 Actions Prior to Services

You acknowledge that you are an autonomous adult with capacity to make your own decisions and exercise your own judgment. You affirm that you are not relying solely on the Provider's guidance but are integrating it with your own critical thinking, consultation with other professionals, and personal decision-making processes.
 

9. CONFIDENTIALITY AND PRIVACY

​9.1 General Confidentiality

SURVIVR National maintains strict confidentiality of all information disclosed during services, consistent with professional ethical standards and legal requirements. Information shared in sessions, correspondence, and documentation will be kept confidential except as outlined in the specific circumstances described in this Agreement.

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​9.2 Limits of Confidentiality

You acknowledge and understand that confidentiality is NOT ABSOLUTE and that the Provider is legally and ethically obligated to breach confidentiality in the following circumstances:

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a) Risk of Harm to Children:

If the Provider has reasonable grounds to believe that a child (any person under 18 years of age) is at risk of abuse, neglect, or harm, the Provider is MANDATED BY LAW to report this information to:

• Child Protection Services

• Police

• Other relevant authorities

This reporting will occur WITH OR WITHOUT your prior notification or consent. The Provider's duty to protect children supersedes confidentiality obligations.

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b) Risk of Harm to Self:

If the Provider reasonably believes that you present a SERIOUS AND IMMINENT risk of suicide or serious self-harm, the Provider may breach confidentiality to:

• Contact emergency services (000)

• Contact your nominated emergency contact person

• Contact your treating medical or mental health professional

• Initiate involuntary mental health assessment if warranted

The Provider will make reasonable efforts to involve you in this process and obtain consent where possible, but may act WITHOUT YOUR CONSENT if required to prevent serious harm.

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c) Risk of Harm to Others:

If the Provider reasonably believes that you present a SERIOUS AND IMMINENT risk of harm to another identifiable person or persons, the Provider is obligated to:

• Warn the intended victim(s) if identifiable

• Notify police or other appropriate authorities

• Take reasonable steps to prevent the harm

This duty to protect others supersedes confidentiality obligations. The Provider may act WITH OR WITHOUT your prior notification or consent.

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d) Court Orders and Legal Obligations:

If the Provider receives a court order, subpoena, or other legal mandate requiring disclosure of information, confidentiality will be breached to the extent required by law. The Provider will:

• Notify you of such legal demands where legally permissible

• Release only the minimum information required

• Seek to protect your privacy to the extent possible within legal constraints

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e) Professional Consultation and Supervision:

The Provider may discuss your case (without identifying information where possible) with:

• Clinical supervisors for quality assurance and professional development

• Professional consultants for case-specific guidance

• Legal or ethical consultants when ethical dilemmas arise

Such consultations are conducted with professionals bound by similar confidentiality obligations.

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f) Insurance, Legal, or Administrative Requirements:

If you have requested that information be shared with insurance providers, legal representatives, or other third parties, or if such sharing is required for billing or administrative purposes related to your care, confidentiality will be limited accordingly.

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g) Medical Emergency:

In the event of a medical emergency during a session or on SURVIVR National premises, emergency medical personnel may be contacted and provided with relevant health information necessary for your treatment.

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​9.3 Group Services Confidentiality

If you participate in group services, you acknowledge that:

a) The Provider cannot guarantee the confidentiality of information shared by other group members;

b) All group members are required to maintain confidentiality but may not do so;

c) You share information in group settings at your own risk;

d) The Provider is not liable for breaches of confidentiality by other group participants; and

e) You agree to maintain the confidentiality of other group members' shared information.

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​9.4 Electronic Communications

You acknowledge that:

a) Electronic communications (email, text message, video conferencing) are not completely secure;

b) There is a risk of breach of confidentiality when using electronic communication methods;

c) SURVIVR National implements reasonable security measures but cannot guarantee complete security;

d) You assume any risks associated with electronic communication; and

e) The Provider may communicate policies regarding acceptable use of electronic communication.

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9.5 Records and Documentation

The Provider maintains clinical records in accordance with professional standards and legal requirements. You acknowledge that:

a) Records include but are not limited to: intake forms, session notes, correspondence, assessments, treatment plans, and other relevant documentation;

b) Records are stored securely in compliance with privacy legislation;

c) You have the right to request access to your records subject to legal and ethical limitations;

d) The Provider may deny access if disclosure would be harmful to you or others, or if records contain information about third parties; and

e) Records will be retained for the period required by law (minimum 7 years from last service date).

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9.6 Privacy Legislation Compliance

SURVIVR National complies with the Australian Privacy Principles under the Privacy Act 1988 (Cth) and any applicable state or territory privacy legislation. Our Privacy Policy, available on our website and upon request, provides detailed information about how we collect, use, store, and disclose personal information.

You acknowledge that you have been provided with access to the Privacy Policy and have had the opportunity to review it.

10. PROFESSIONAL BOUNDARIES

​10.1 Therapeutic Relationship

The relationship between you and SURVIVR National is a professional therapeutic relationship with defined boundaries. You acknowledge that:

a) The relationship exists solely for the purpose of providing transformational support services;

b) Dual relationships (social, business, romantic, or other non-professional relationships) are prohibited and would result in termination of services;

c) Contact outside of scheduled sessions is limited to brief administrative or check-in communications;

d) The Provider will maintain appropriate professional boundaries at all times; and

e) You agree to respect these boundaries and bring concerns about boundary issues to the Provider's attention.

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​10.2 No Personal Relationship

You acknowledge and agree that participation in SURVIVR National services does not create a personal friendship, ongoing supportive relationship beyond the service period, or obligation of the Provider to maintain contact after services conclude.

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11. FINANCIAL AGREEMENT

​11.1 Fees and Payment

You acknowledge and agree that:

a) Fees for services have been clearly communicated to you prior to commencement;

b) You are responsible for payment of all fees according to the agreed payment schedule;

c) Payment is due at the time of service unless alternative arrangements have been made in writing;

d) Failure to pay fees may result in suspension or termination of services;

e) Outstanding fees may be subject to collection processes, including potential legal action; and

f) You are responsible for any bank fees, currency exchange fees, or other financial transaction costs.

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​11.2 Cancellation and No-Show Policy

You acknowledge that:

a) Cancellations must be made at least 48 hours prior to scheduled appointment time;

b) Cancellations made with less than 48 hours notice may incur a cancellation fee;

c) Failure to attend a scheduled session without notice (no-show) may result in full session fee being charged;

d) Repeated cancellations or no-shows may result in termination of services; and

e) Exceptions may be made for genuine emergencies at the Provider's discretion.

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​11.3 No Refund Policy

You acknowledge that fees paid for services are NON-REFUNDABLE except:

a) Where services cannot be provided due to Provider unavailability and rescheduling is not possible; or

b) As required by applicable consumer protection laws.

You specifically acknowledge that:

• Fees are not refunded if you choose to discontinue services;

• Fees are not refunded if you are dissatisfied with services;

• Fees are not refunded if you do not achieve desired outcomes; and

• Program fees paid in full are not pro-rated if you withdraw partway through.

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12. TERMINATION OF SERVICES

​12.1 Your Right to Terminate

You may terminate services at any time by providing written notice to SURVIVR National. You remain financially responsible for any services already provided and, depending on the terms of your Service Agreement, may have ongoing financial obligations for prepaid programs.

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​12.2 Provider's Right to Terminate

The Provider reserves the right to terminate services if:

a) You fail to comply with policies or agreements;

b) You engage in threatening, harassing, or abusive behaviour toward the Provider or others;

c) You fail to pay fees as agreed;

d) Your clinical needs exceed the scope of services offered by SURVIVR National;

e) You require a level of care (crisis intervention, inpatient treatment, specialized medical care) that SURVIVR National cannot provide;

f) The Provider determines that services are no longer clinically appropriate or beneficial;

g) A conflict of interest arises that cannot be resolved; or

h) The therapeutic relationship has irreparably broken down.

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​12.3 Referrals Upon Termination

If services are terminated and you require ongoing support, the Provider will, where appropriate, provide referrals to other qualified professionals or services. However, the Provider is not obligated to arrange alternative care and is not responsible for your engagement or outcomes with any referred providers.​

13. COMPLAINTS AND DISPUTES

​13.1 Complaint Process

If you have a complaint or concern about services, you are encouraged to:

a) Raise the concern directly with the Provider;

b) Provide written notice of the complaint if unable to resolve verbally;

c) Allow reasonable opportunity for the Provider to investigate and respond to the complaint.
 

13. COMPLAINTS AND DISPUTES

​13.1 Complaint Process

If you have a complaint or concern about services, you are encouraged to:

a) Raise the concern directly with the Provider;

b) Provide written notice of the complaint if unable to resolve verbally;

c) Allow reasonable opportunity for the Provider to investigate and respond to the complaint.

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​13.2 External Complaints

If you remain dissatisfied after following the internal complaint process, you have the right to lodge a complaint with:

• Australian Health Practitioner Regulation Agency (AHPRA) (if applicable)

• Australian Association of Social Workers (AASW) (if applicable)

• Office of the Australian Information Commissioner (privacy complaints)

• Consumer protection agencies in your state or territory

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​13.3 Dispute Resolution

You agree to make reasonable efforts to resolve any disputes through negotiation and, if necessary, mediation before pursuing legal action.
 

14. LEGAL JURISDICTION AND GOVERNING LAW

​14.1 Jurisdiction

This Agreement is governed by the laws of the State of Victoria, Australia, and the Commonwealth of Australia. Any disputes arising from this Agreement or the provision of services will be subject to the exclusive jurisdiction of the courts of Victoria, Australia.​
 

​14.2 Severability

If any provision of this Agreement is found to be invalid, illegal, or unenforceable, the remaining provisions will continue in full force and effect to the fullest extent permitted by law.

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​14.3 Entire Agreement

This Agreement, together with any Service Agreement, Privacy Policy, and Terms and Conditions of Service, constitutes the entire agreement between you and SURVIVR National regarding the provision of services and supersedes any prior oral or written agreements or understandings.

15. ACKNOWLEDGMENT AND CONSENT

By signing below, you acknowledge, affirm, and agree that:

✓ You have READ THIS ENTIRE AGREEMENT carefully and in its entirety;

✓ You have had adequate OPPORTUNITY TO ASK QUESTIONS and have received satisfactory answers to all questions;

✓ You FULLY UNDERSTAND all terms, conditions, risks, and limitations outlined in this Agreement;

✓ You have been informed of your RIGHT TO SEEK INDEPENDENT LEGAL ADVICE before signing this Agreement and have either done so or voluntarily waived this right;

✓ You CONSENT to participate in SURVIVR National services with full knowledge of the nature, risks, and limitations of services;

✓ You have consulted with your MEDICAL PRACTITIONER regarding participation and have been medically cleared;

✓ You affirm that you are currently in a STABLE MENTAL STATE sufficient to participate safely;

✓ You ACCEPT ALL RISKS associated with participation in services;

✓ You RELEASE AND WAIVE ALL LIABILITY against SURVIVR National and all Released Parties as outlined in Section 8;

✓ You understand that SURVIVR National is NOT A CRISIS SERVICE and agree to utilize appropriate emergency services if needed;

✓ You understand the LIMITS OF CONFIDENTIALITY and consent to necessary breaches as outlined in Section 9;

✓ You agree to all FINANCIAL TERMS outlined in this Agreement and any associated Service Agreement;

✓ You are participating in services VOLUNTARILY and may withdraw at any time; and

✓ This Agreement represents your FREE AND INFORMED CONSENT to all terms outlined herein.

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END OF AGREEMENT

SURVIVR National | Victoria, Australia

 Email: connect.survivr@outlook.com  | Web: www.survivrnational.org