Informed Consent

Purpose

Thank you for taking the time to review this form. This is to provide some important guidelines before we start the therapy collaboration together.

Here's some important information about the counselling and psychological services that will be provided to you.

 

Informed Consent

By agreeing to this, you are fully aware that you are being provided with counselling services by a trained therapist/counsellor. As such, you are also aware that your confidentiality will be maintained by the therapist/counsellor.

 

Your privacy and confidentiality

You agree and understand that all interactions with the therapist/counsellor, including the content of your sessions, progress in counselling as well as any notes taken are kept confidential.

However, you are also aware of the exceptions to confidentiality. Disclosure of information pertaining to your counseling sessions to a third party is deemed necessary in the following circumstances:

 

Duty to Warn and Protect

If you disclose a plan or threat to harm yourself and/or others, the counsellor must attempt to notify your family, the possible victim and/or the legal authorities.

 

Abuse of Children and Vulnerable Adults

If you disclose, or it is suspected, that there is abuse or harmful neglect of children or vulnerable adults (the elderly, disabled/incompetent), the counsellor must report this information to the appropriate state agency and/or legal authorities.

 

Consultation with third parties

There may be times when your counsellor consults with his clinical supervisor to provide the best possible care. You understand that no identifiable information will be used to discuss the case.

 

Rights of the minor (under 18)

If you are under the age of 18, your parents (or legal guardian) have the right to examine your treatment records. Before giving them any information, your clinician will discuss the matter with you, and do his / her best to handle any objections you may have. It is important for you to understand that your clinician will provide a summary report written in your best interests.