• Information obtained within the counselling sessions will not be released without the written consent of all parties or a court order.
• If a client threatens bodily harm to self or others • If there is indication of child abuse • Counsellors under subpoena are bound by law to disclose information obtained during the course of counselling
• 24 hour notice of cancellation is requested or the full session fee will be charged • Includes clients whose fees are paid by 3rd parties who do not cover missed appointments
I also agree to the use of the telemedicine portal, Doxy.me, for the purposes of virtual counselling, and I understand that this platform is PIPA/PIPEDA compliant for security and privacy.
Client Signature ______________________________________________________________________ Date__________________________________________