Informed Consent
I voluntarily requested for medical care and counselling services at Conscious Mental Wellness, MCM Dubai located at Icon Tower, Suite 1103, Barsha Heights, Dubai, UAE. And I hereby agree to accept the services to diagnose my psychological condition and to be recommended with psychological care as determined necessary, and/or ordered by healthcare professionals involved.
Confidentiality in Psychological Services
Confidentiality is a fundamental aspect of the therapeutic relationship at Conscious Mental Wellness (MCM Dubai). We are committed to maintaining the privacy and confidentiality of all client information.
1. Strict Privacy: All information shared and discussed with your clinician is considered strictly private. Your clinician is ethically and legally bound to safeguard the confidentiality of your sessions.
2. Exceptions to Confidentiality Serious and Imminent Harm: If there is clear evidence of serious and imminent harm to the client or to others, the clinician may be obligated to disclose information. This means that if a client expresses a credible threat of harm to themselves or someone else, the clinician may need to take action to ensure safety. This action might involve informing relevant authorities or individuals who can intervene to prevent harm.
Abuse or Neglect: If there is reason to suspect abuse (sexual, emotional, or physical) or neglect of a child or vulnerable adult, the clinician may have a legal and ethical duty to report such suspicions to the appropriate authorities for the protection of the vulnerable person involved.
Misconduct by Other Health Professionals: In cases where a client reports misconduct, particularly of a sexual nature, by another health professional, the clinician may be legally required to report such misconduct to the relevant regulatory body, ensuring that ethical and professional standards are upheld within the healthcare community.
Subpoena by Court: If client records are deemed relevant and subpoenaed by a court of law or a regulating body of health professionals, the clinician may be legally compelled to provide the requested information. In such cases, the clinician will make reasonable efforts to limit the information disclosed to what is necessary for the legal process.
Clinical Services
The type and extent of services that the client will receive will be determined following an initial intake consultation and thorough discussion with the assigned clinician. At MCM Dubai, we guarantee highly qualified and licensed professionals, including doctoral-level psychologists, and masters-level psychology practitioners, and other allied health professionals. The goal of the consultation process is to determine the best course of intervention for the client. Types of services provided in these departments include initial consultation and assessment, online and face- to- face individual and family therapy, group therapy, occupational therapy, parenting sessions, intensive psychotherapy, mindfulness, and support groups for a wide range of presenting concerns. Typically, assessment and/or treatment are provided over the course of several sessions and/or weeks, or longer. Each client will have an individualized plan according to their needs and the clinician’s recommendations.
I acknowledge that no guarantees or promises have been made to me by MCM Dubai clinicians and staff regarding the results and the outcomes of such diagnostic procedures and/or psychological treatments.
I understand that MCM Dubai is an outpatient clinic without an inpatient admission/treatment facility. if an emergency arises. I can seek help by calling 998.
MCM Dubai will send SMS/WhatsApp/Phone/ Email reminders to my registered number/email address. And I agree to update MCM Dubai if there are any changes in my contact details.
I understand that as part of the 'Care Plan' system, my clinician may designate one of the staff from MCM Dubai to follow up with me on specific things like health progress, and holistic well- being.
Payment & Cancellation Conditions
Fees are typically due at the end of each session. Note that a psychology “treatment hour” is equivalent to 50-60 minutes direct client time.
Twenty-four (24) hours notice is required for appointment cancellations or a charge of 300AED for the missed session may be applied. You may withdraw from assessment/treatment at any time but must take financial responsibility for all outstanding fees. If your account has not been paid for more than 30 days and arrangements for payment have not been agreed upon, MCM Dubai has the option of using legal means to secure payment. By signing below, I understand and agree that the fee for service rendered cannot be refunded in any case by MCM Dubai.
I understand that all fees once paid are non-refundable. However, if the session was not utilized, the refund request will be processed after internal approvals. I agree that only 50% of the fee will be refunded and the refund process may take up to 30 days.
Contacting the Clinician
Clinicians are not often immediately available by telephone, particularly during business hours when seeing other clients. However, you may leave a message with the front desk officer or contact your clinician by email at anytime. Clinicians will make every effort to respond to your message by the next business day. In case of emergencies, please contact your local emergency clinic or police authorities. Note that while clinicians provide brief courtesy phone calls as needed, extended communication contact requires formal appointment booking, with respective fees.
Client's Rights and Responsibilities
Clients at MCM Dubai have the right to discuss any concerns or questions regarding confidentiality with their clinician. It is essential for clients to understand their rights and responsibilities in the therapeutic process. You have the right to know that your discussions with your clinician are confidential, with the exceptions outlined above. It is your responsibility to be open and honest in your communication with your clinician, as this is essential for effective treatment.
By signing this informed consent, you acknowledge that you have read and understood the confidentiality provisions and agree to abide by them. You understand that while your privacy is of utmost importance, there are specific circumstances in which confidentiality may be breached in the best interest of your well- being or the well-being of others.
Please feel free to discuss any questions or concerns you may have regarding confidentiality with your clinician. Your clinician is here to support you and ensure your well-being while upholding the highest ethical and professional standards in the field of psychology.
By accepting this service from MCM Dubai, I irrevocably and unconditionally waive all claims, and I hereby release MCM Dubai, including, but not limited to, its psychologists, officers, directors, employees, contractors, subcontractors (of any tier), licenses or invitees (the “Indemnitee”) from any liability whatsoever arising from or in connection with the services from MCM Dubai.
Notwithstanding anything to the contrary, the foregoing limitation on liability and indemnification obligation shall continue in full force and effect after and notwithstanding the expiration or termination of this agreement.
Upon signing this consent, I hereby free MCM Dubai clinicians, staff, and the whole facility from sue or any charges as I have been made aware of the limitations, rights, and responsibilities of the parties involved.