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INTELLECT CARE – Informed Consent Form

Welcome to Intellect Care (“Intellect” or “Company”). 

Intellect’s mission is to make mental health care accessible to everyone. Your employer has partnered with Intellect to provide mental health services to you and your immediate family. Intellect’s mission is to make mental health care accessible to everyone no matter what their mental health needs are.

By signing this Informed Consent Form, you acknowledge and consent to referral via your employer’s well-being manager. 

Please read this carefully.

Collection and Use of Personal and Health Information

Intellect collects and maintains information related to your health and well-being. 

All of our network partners, staff, clinicians, counsellors, and coaches (“Providers”) are committed to the secure management and maintenance of this information according to: 

(i) applicable laws in Singapore (in particular, the Singapore Personal Data Protection Act 2012 (PDPA)) and 

(ii) any other applicable data protection law in the jurisdiction where you are based, in particular the legislation specified in the Exhibit below.

We collect your personal and health information when you first reach out to book an appointment with Provider(s), and during the period of your care with Intellect. 

This information enables us to:

  • Schedule necessary appointments
  • Alter appointments in case of staff unavailability
  • Confirm your eligibility for our services through external agencies/clinics/services
  • Assess issues related to your presenting concerns, and
  • Maintain or improve your psychological health and wellbeing

Obtaining Information About Your Case From Other Professionals Or Agencies

To provide the best possible care, Intellect may seek your approval to contact the referring doctor to clarify the referral or seek an opinion on your case. 

Intellect may also seek your approval to request information from therapists or agencies who may have assessed or treated you in the past. 

Modality of Sessions

Intellect conducts either face-to-face in-person sessions or remote, online telehealth sessions through Intellect’s app. 

Intellect reserves the right to change the modality of sessions from face-to-face to virtual sessions if government regulations and precautionary measures require this (e.g., during the occurrence or resurgence of a pandemic or other similar events). 

Confidentiality Agreement

Your Provider(s) bear a legal, ethical, and professional responsibility to ensure that all details of all sessions are kept private and confidential, along with any information pertaining to your person and care that is obtained for the purpose of your care. 

Only session utilisation will be shared with your organisation, and no information which may identify you will be disclosed.

All information provided to the Provider will be treated in professional confidence. Your case will not be discussed outside formal supervised arrangements. This applies for both face-to-face in-person and telehealth sessions.

Exceptions to Confidentiality Agreement

These are circumstances under which your Provider may need to break confidentiality by informing other parties about your care or share information about your person, or is obliged to do so by the law:

  • Failure to disclose the information would place you or another person at risk of harm.
    • Cases in which the purpose of such disclosure is clearly in your  interests, and if consent cannot be obtained in a timely way
    • Assessment and interventions related to your concerns are to be conducted by other health professionals;
  • If a disclosure of facts/incident requires Intellect to submit a report to the necessary regulatory or law enforcement authorities.
  • When your information is subpoenaed by a court and such disclosure is otherwise required by law.
  • I have authorised permission for release, either verbally or in writing.

Whenever possible, your Provider will discuss the matter of breaking confidentiality before doing so.

Intellect Escalation Protocol

We adopt the Intellect Escalation Protocol in the process of disclosing confidential information. 

You agree that you have reviewed the Intellect Escalation Protocol and hereby consent to such disclosure of confidential information as per the Intellect Escalation Protocol.

Supervision

From time to time, your Provider will discuss your case with their supervisor. This is standard practice and serves to ensure that you receive the best possible care with Intellect. 

Your Provider’s supervisor is bound to the same strict confidentiality policy and cannot disclose any information pertaining to your person or care, with the exception of scenarios specified above.

Fees & Cancellation

The following applies to both face-to-face and virtual sessions. These sessions are fully covered by your company, and the number of covered sessions have been communicated to you at the launch of Intellect’s services. 

Before the entitled sessions are completed, the Provider shall discuss further follow-ups, if necessary.

It is important that you attend your appointments on time to achieve maximum results. If  you need to cancel or reschedule your appointment, please give your Provider at least 24-hour notice.

Your Provider will regularly review your treatment plan with you, including your goals, progress, and motivation for treatment. 

Whenever possible, your Provider will jointly discuss the need to refer you to a service more suited to your care, or discuss any upcoming discharge from treatment. Likewise, you may also withdraw from therapy at any time.

Information Used for Other Purposes

Intellect may use service-wide, statistical, non-identifying material for the management, planning, and monitoring, planning and provision of services with the aim to improve or evaluate the services we offer. 

In such cases, data will be presented as group statistics and no individual data or information will be shared. We may share such data without any individual identification with research bodies investigating well-being, health management, and health promotion initiatives.

Access to Information

You have a right to access your personal information. 

If you wish to make a formal request to access your information, you need to do this in writing to support@intellect.co.

Disclaimer

By signing the Informed Consent, you acknowledge  that Intellect does not recommend, endorse or make any representation about the efficacy, appropriateness, or suitability of any specific tests, products, procedures, treatments, services, opinions, or health care providers. 

You agree to receive mental health assessment, care, treatment, or services and authorise the therapist to provide such care, treatment, or services at your sole risk. 

You acknowledge and agree that Intellect, its officers, partners, service providers, therapists, contractor, or sub-contractor, will not be liable to you, whether by indemnity, by statute, in tort, or any other basis in law or equity, for loss of data, economic loss, punitive or exemplary damages, or any incidental, special, indirect or consequential loss or damage which may be suffered by you in connection with the mental health assessment, care, treatment, or services, including any death or personal injury caused as a result of the services.

Zero Tolerance of Aggressive Behaviour towards Staff

At Intellect, we adopt a strict zero tolerance attitude towards any form of violent, threatening or abusive behaviour made towards our staff in person, over the phone, video calls or email. Aggressive behaviours may include, but are not limited to, verbal abuse, shouting, offensive or derogatory remarks, verbal threats or physical attacks.

Following any incident in which our staff are abused, threatened, or assaulted while performing their duties by a client, their relatives, or associates, Intellect reserves the right to immediately terminate the treatment or case. Additionally, at its discretion, Intellect may report the incident to the appropriate authorities or police if the situation warrants.

Release of Information (Adult)

I agree and give consent for Intellect to contact my company, emergency contact, and/ or the relevant authorities should any of the following events occur:

  • I am uncontactable for more than 48 hours without prior notice, and
  • If I disclose that I or someone else may be at risk (whenever possible, my Provider will endeavour to give me notice prior to communicating details of my “at risk” disclosure to the contact person(s) or to such third parties as may be deemed necessary).
  • Other unforeseen circumstances that raise a reasonable suspicion of risk to myself or others.
  • To obtain and/or release any information that may be of relevance or value in my care and treatment.

Unless otherwise indicated under the “remarks” columns, information that may be released to the said persons on a need-to-know basis, may possibly include the release of some sensitive or confidential information about myself, where deemed necessary to ensure my safety and wellbeing.

By continuing, I understand the nature and limits of confidentiality, and what is expected of me as a client of Intellect Services. I agree to indemnify the Company and/or the Provider from any and all actual or alleged claims, demands, causes of action, liability, and/or injury (to property or persons, including without limitation wrongful death), whether brought by me, any individual, or other entity.