Knox Counselling Centre Intake and Consent Form
  • Knox Counselling Centre Intake and Consent Form

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  • If you are a U of T student, our services are free for you. Below, please enter your U of T email address for verification purposes. If you are from the general community, enter an email that you check frequently.

  • For the general community, we offer a sliding scale of affordable fees. 

    No income: Free
    - For students, seniors, or unemployed

    Low income: $20
    - For individuals or families with limited financial resources below $30,000 per year

    Middle income: $40
    - For individuals or families with moderate financial resources between 30,000 ~ $60,000 per year

    Affordable Income: $80
    - For individuals or families with affordable financial resources above $60,000 per year

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  • Cancellation Policy

    Your appointment time is reserved just for you. A late cancellation or missed visit leaves a hole in the therapists’ day that could have been filled by another client. As such, we require a minimum of 48 hours notice for any cancellations or changes to your appointment. Clients who provide less than 48 hours notice, or miss their appointment, will be charged a cancellation fee to the credit card on file.

    For the general community:
    Canceling within 24 hours incurs a 50% fee.
    Not showing up incurs the full fee.

    For U of T students:
    Canceling within 24 hours incurs a $10 fee.
    Not showing up incurs a $20 fee.

    If there are two consecutive no-shows without explanation or not in the case of an emergency situation, your spot with your matched therapist will be forfeited and you will be moved to the wait list.

  • Informed Consent

    Before beginning your counselling sessions, it is important that you understand what to expect, as well as your rights and responsibilities as a client. This informed consent document is intended to provide clarity and transparency about the counselling process so that you can make an informed decision about whether to begin services.

    Counselling services at Knox Counselling Centre are informed by the ethical standards of the Canadian Association for Spiritual Care (CASC) and College of Registered Psychotherapy of Ontario (CRPO).

     

    Risks and Benefits of Therapy

    Potential Benefits
    Therapy may help you gain insight, develop coping skills, process difficult experiences, improve relationships, and enhance emotional and spiritual well-being.

    Potential Risks
    Therapy can involve exploring painful emotions, past wounds, losses, or traumatic experiences. This may lead to temporary emotional distress or discomfort. While therapy is often beneficial, there is no guarantee of specific outcomes, and progress varies from person to person.

     

    Confidentiality and Its Limits

    Your privacy is of utmost importance. Information shared in counselling is kept confidential and will not be disclosed without your written consent, except in the following circumstances required by law, ethical obligation, or professional standards.

    1. Legal and Ethical Obligations
    Confidentiality may be broken in the following situations:

    • Risk of Serious Harm: If there is a serious and imminent risk of harm to yourself or others, the therapist is required to take reasonable steps to protect safety, which may include contacting emergency services or appropriate professionals.
    • Abuse or Neglect: Therapists are legally required to report suspected abuse or neglect of a child, elder, or vulnerable adult.
    • Court Orders: Therapists must comply with subpoenas, court orders, or other legal requirements. Only the information legally required will be disclosed.

    2. Supervision and Professional Consultation
    As part of CASC-aligned practice and intern education, your therapist may consult with a supervisor, educator, or professional colleagues to support ethical, competent care. These consultations are confidential, and identifying information will be minimized whenever possible.

     

    Emergency Policy

    Knox Counselling Centre does not provide emergency or crisis services. Clients are responsible for seeking immediate help in emergency or crisis situations.
    In emergency or crisis situations, please contact:

    Distress Centres of Toronto: 416‑408‑4357
    911, or Your nearest emergency room


    Communication by Email or Text

    Email and text communication may be used only with your written permission and solely for administrative purposes such as scheduling or billing.

    • Email and text are not secure and should not be used for clinical matters.
    • Clinical concerns should be addressed during scheduled counselling sessions.

     

    Social Media and Professional Boundaries

    Therapists do not communicate with clients through social media platforms (e.g., Facebook, Instagram, LinkedIn). This policy protects your confidentiality and maintains professional boundaries.

    If you encounter your therapist online or have questions about boundaries, please discuss this in a session rather than attempting contact through social media.

     

    Online Counselling (Teletherapy)

    Online counselling is provided through secure video conferencing or telecommunication platforms.

    Benefits

    • Increased accessibility
    • Flexible scheduling
    • Reduced travel time

    Risks and Responsibilities

    • Confidentiality may be compromised if others can overhear your session.
    • Clients are responsible for ensuring a private space and securing their devices.
    • Technical difficulties or interruptions may occur.
    • Although rare, security breaches are possible.
    • Clients are responsible for obtaining and maintaining any necessary equipment or software.

    Client Location and Jurisdiction

    Online counselling services are provided only to clients who are physically located in jurisdictions where the therapist is legally permitted to practice. Clients must inform the therapist of their physical location at the time of each online session.

    Recording Policy

    Counselling sessions must not be recorded by either the client or the therapist unless written consent is provided by both parties in advance.


    Session Duration, Limits, and Intern Placement

    Counselling continues only as long as it is beneficial and aligned with your therapeutic goals.

    Counselling may conclude when:

    • Your goals have been met
    • You request to end counselling
    • You reach the maximum of fifteen (15) sessions

    Additional sessions beyond fifteen may continue with mutual agreement between a therapist and a client.

    Therapist interns are available only during their placement period at Knox Counselling Centre (typically September to March, with possible summer availability depending on centre operations). Continuity with the same therapist intern cannot be guaranteed across placement periods. If further counselling is desired, clients may return in September and may be placed on a waitlist.


    Client Rights

    You have the right to:

    • Ask questions about counselling at any time
    • Participate actively in goal-setting
    • Decline or withdraw consent at any time
    • Be treated with dignity, respect, and cultural/spiritual sensitivity


    Client Acknowledgment and Consent

    By signing below, you acknowledge that:

    • You have read and understood this informed consent document
    • You understand the limits of confidentiality
    • You have had the opportunity to ask questions and receive satisfactory answers
    • You consent to participate in counselling or psychospiritual therapy under these conditions

    You may withdraw your consent at any time.

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