I, the undersigned, grant Taryn Steyn permission to treat myself or legal guard in her capacity as a clinical psychologist. I accept that she does not do assessments or reports for legal purposes.
A therapeutic relationship can only be successful when clearly defined rights and responsibilities are held by both client and therapist. In maintaining this, an environment is created that ensures a safety to take risks and provide support to empower and create change.
Psychotherapy entails both risks and benefits. The risks sometimes include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness. Psychotherapy often requires discussing unpleasant aspects of your life. However, psychotherapy has been shown to have benefits for the individuals who undertake it. It often results in significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems. In saying this psychotherapy requires a very active effort on your part, you will have to work on things that we discuss in and out of session time.
Scheduled appointments will be agreed upon and will be a 51-60 minute session. In an event of a cancellation or rescheduling, 24 hours’ notice is required. If you have missed a session without cancelling you will be held liable for that payment. An amount of R250 will be charged for a missed appointment or late cancellation, this will not be claimed by your medical aid, but paid by you personally. You are responsible for coming to your session on time and at the time scheduled. If you are late your appointment will still need to end on time.
Professional Fees, medical aids and administration
I understand that Taryn Steyn’s consulting fees are in accordance with the Board of Healthcare Funders of South Africa. I accept that sessions are charged at medical aid rates and are subject to annual increase.
Hourly fees are based on Medical Aid rates, although your medical aid may be paying, you remain responsible for payment of services rendered unless prior arrangements have been made. It is your responsibility to familiarise yourself with the benefits, and terms and conditions of your medical aid. When claiming through the medical aid, additional information (diagnosis and progress related) may be required as per their terms on conditions.
This Practice makes use of registered claims company smeMetrics for administration and claim processing, whom is bound by the confidentiality agreement of the practice.
Accounts are handed over for legal debt recovery after 90 days. Any cost associated with such actions will be incurred towards the person responsible for the account. This may result in having a bad credit record.
If you are not the medical aid’s principal/main member you agree that the member is aware of the consultation and that they have given permission for the sessions to be claimed from your medical aid. A copy of your medical aid card and identification is required with your first session.
I, the undersigned, accept full responsibility for my account and to settle any outstanding payments. Moreover, I accept full responsibility to ensure that I have received the necessary invoices for sessions that I have attended.
If my invoices are paid at private rates, I understand that it is my responsibility to make payment on the date of the therapy session. Taryn Steyn will make available credit and debit card facilities to make this payment process possible, although a payment via EFT is recommended to the following bank account.
The banking details are as follows:
Bank : FNB
Account : Taryn Steyn
Branch Name : New Market Mall
Branch Code : 250655
Type of Account : Current/Cheque Account
Account Number : 62634628658
Reference : <Your Full Name>
If my invoices are being submitted to medical aid, I understand that it is my responsibility to liaise with my medical aid regarding payments due and keeping up-to-date with my available funds. If my account has not been paid for a period of 30 days or more, the full payment will be processed against the authorised bank account. If you’re a medical aid client, a payment on your account will only be processed if the medical aid has not paid the submitted invoice, and it is clearly indicated on the medical aid remittance. You will be notified of this rejection, and of the date that the payment will be processed on your account. The estimated time to get a payment from the medical aid is 4-6 weeks from the date that the invoice is submitted. With all rights reserved, Taryn Steyn has the option to use legal methods to secure payment; this may include a collection agency or small claims court, in which case the cost of such measures will be added to the claim. Notices of outstanding accounts will be served to your residential, postal and work addresses.
I understand that Taryn Steyn may suspend therapy until all outstanding accounts are settled in full.
I am required to keep appropriate records of the psychological services that I provide. Although psychotherapy often includes discussions of sensitive and a private nature, a very brief summary of the therapeutic themes and process will be noted. Your records will be maintained in a secure location.
Therapy content is considered confidential. There are however legal exceptions to confidentiality which would include, but not limited to the following:
1 :: Should you disclose an intention to harm yourself or another person.
2 :: Should there be a suggestion that you are or have been involved in the abuse of a child or vulnerable adult.
3 :: Medical Aid and Third Parties (when applicable): Medical Aids and other third-party payers are given information that they request regarding service to clients. Information that may be requested includes type of services, dates/time of services, diagnosis, treatment plan and progress of therapy.
Finally, there are times when I find it beneficial to consult with colleagues as part of my practice for mutual professional consultation. Your name and identifying details will not be disclosed.
This Practice does not deal with forensic assessments or court related cases. Any reports, motivational letters or forms requested will incur a fee which will be charged according to the duration of time spent on compiling the report.
If you need to contact me between sessions, or in an emergency, you have the right to a timely response. You may message or email and I will respond as soon as possible or by the next business day. If for an unforeseen reason you do not hear from me or I am unable to reach you, it remains your responsibility to take care of yourself until such time we can talk. If you feel unable to keep yourself safe, please go to your nearest hospital and ask to speak to the psychiatrist on call.
I understand that if an appointment is not cancelled with 24 hour advance notice I will be charged to me in full. The debit order authorisation, as completed before, will be used to process payment against your authorised bank account. I accept that appointments are taken as confirmed at the time of verbal booking. Any reminders from Taryn Steyn serve as a courtesy and have no bearing on the confirmation of an appointment.
I acknowledge that phone calls and emails that are longer than 10 minutes will be charged for.
Any sessions/consultations with third parties will be charged to the undersigned, even if at the request of Taryn Steyn. With regard to minors, feedback sessions to parents are charged in full.
I understand that that the email address and mobile number provided provided by me below will be used for all correspondence related to my appointments and invoices. Should I not receive the related invoice within 5 working days after a session (those that are attended or missed), I will be responsible for ensuring that I follow-up and ensure that I do have a copy of the related invoice.
I, the undersigned, accept that any late-coming will shorten the length of my session and I will be charged in full. Sessions cannot run overtime if the client is late.
Note that the information below with a ‘*’ is mandatory. If you don’t have this information, you can enter a ‘-‘. However, if the information is missing or inaccurate, it will result in a delay of the appointment scheduling, billing process and/ or medical aid follow-up process.
The contract terms in terms of the debit order can be found lower on this page, for your reference.
The following are the terms of the debit order for your reference:
This signed Authority and Mandate refers to our contract as dated as on signature hereof (“the Agreement”). I/We hereby authorise you to issue and deliver payment instructions to the bank for collection against my/our abovementioned account at my/our above mentioned bank (or any other bank or branch to which I/We may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in the Agreement, and commencing on the commencement date and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of no less than 30 ordinary working days, and sent by prepaid registered post or delivered to your address indicated above.
The individual payment instructions so authorised to be issued must be issued and delivered as follows:
Daily; on or after the dates when the obligation in terms of the Agreement is due and the amount of each individual payment instruction may not be more or less that the obligation due;
I/We understand that the withdrawals hereby authorised will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction. I/We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
I/We acknowledge that all payment instructions issued by you shall be treated by my/our above mentioned bank as if the instructions had been issued by me/us personally.
As per outstanding invoices processed by Taryn Steyn.
I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/We shall not be entitled to any refund of amounts which you have withdrawn while this authority was in force, if such amounts were legally owing to you.
I/We acknowledge that this Authority may be ceded to or assigned to a third party if the agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.