I, hereby agree to receive psychological services from Allegro Counselling Inc. of Alberta, Canada. The terms of this agreement are as follows:
Services: Allegro Counselling Inc. agrees to provide psychological services to the Client, which may include but are not limited to individual therapy, couples therapy, family therapy, and assessments.
Therapist: The services will be provided by a licensed and / or qualified therapist employed by Allegro Counselling Inc. or a contracted professional, or an individual being supervised by a professional counsellor.
Confidentiality: All information disclosed within the context of the therapeutic relationship is confidential and will not be disclosed to any third party without the explicit written consent of the Client, except where required by law.
Indemnity: The Client agrees to indemnify and hold harmless Allegro Counselling Inc., its therapists, employees, and contractors, from any claims, actions, or demands arising out of the services provided, except those resulting from gross negligence.
Records and Privacy Laws: Allegro Counselling Inc. maintains records of services provided in compliance with the Health Information Portability and Accountability Act (HIPAA) as applicable. The Client has the right to request access to their records, with reasonable notice.
Fees and Payment: The Client agrees to pay the agreed-upon fees for services rendered. Fees may be subject to change, and the Client will be provided with reasonable notice of any changes.
Cancellation Policy: The Client agrees to provide at least 3 hours notice in case of appointment cancellation. Failure to provide adequate notice may result in a cancellation fee of 50 dollars.
Telehealth Therapy Informed Consent
Telehealth therapy is an emerging form of healthcare delivery that allows for remote communication between a mental health provider and a patient. It utilizes electronic means to conduct sessions, including video conferencing and phone calls. Before engaging in telehealth therapy, it is important for you to understand the following guidelines and policies:
Telehealth Services: We offer the following telehealth services: video sessions and phone sessions. Please note that not all services may be appropriate for every individual.
Disclosure of Location and Travel: Due to jurisdictional variability, it is important for you to disclose your current location and inform us if you plan to travel during the course of our work together.
Strengths and Limitations of Telehealth Counselling: Telehealth is an emerging form of healthcare delivery with its own set of strengths and limitations. Some positives include convenience and accessibility, while potential risks include issues related to privacy and connectivity.
Confidentiality Limits: It is important to be aware of the limits of confidentiality, especially when using phones or email for communication. While we take measures to ensure privacy, there may be risks associated with electronic communication.
General Delivery Factors: Electronic service delivery may differ from face-to-face sessions. It is recommended to have a computer or device that meets the minimum technical specifications for a reliable connection.
Information and Emergencies:Please provide updated contact information, including an emergency contact. In the case of a crisis or emergency, please reach out to 1-877-303-2642.
Alternatives to Telehealth:If it is deemed that telehealth is inappropriate for your situation, we will discuss alternative options for care.
Communication Guidelines:
Our practitioners strive to respond to messages within an appropriate timeframe. There may be specific times or circumstances when practitioners are not able to respond and in that case, you are to notify info@allegrocounselling.com.
In case of technical difficulties or non-receipt of communications, please refer to the provided list of alternatives and behavioral suggestions. Additionally, be aware that SMS messages are not permitted with Allegro Counselling.