Please carefully read the two tabs of consent forms below and submit your agreement

• 1- CONSENT FOR PSYCHOTHERAPY/COUNSELLING
• 2- CONSENT FOR ELECTRONIC COMMUNICATIONS

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Welcome! This informed consent form will answer most of your questions about what psychotherapy is and what you can expect from this process. Please feel free to ask for clarifications or additional information. 

Benefits and Risks of Psychotherapy

​Many people find psychotherapy very beneficial for their personal, interpersonal, love and professional life. However, psychotherapy sometimes can bring to the surface emotions, which may be found uncomfortable to deal with. There is no guarantee of improvement for every situation. Nevertheless, I have been trained to use interventions and techniques that have been researched and proven to be helpful for most people.

Your Rights as a Client

You have the right to feel safe in your psychotherapy and with me. You have the right to ask about my professional training, qualifications, background, and psychotherapy orientation. If at any time during the psychotherapy you have questions about whether or not the psychotherapy is effective, about something I have said or suggested, or if you need clarification of psychotherapy goals or treatment plan, you have every right to bring this up in your session. You also always have the right to not discuss a topic, or terminate the session or psychotherapy.

Client-Therapist Relationship

You and I have a professional relationship established based exclusively on therapeutic treatments. This relationship works best when it stays professional and involves only the therapeutic aspects. This works best by strictly focusing on therapeutic relationship and avoiding any sorts of social or business interactions. 

Confidentiality

By law and professional ethics, your psychotherapy sessions and all communication with your psychotherapist are confidential. This means that what is discussed with me remains private. Should we have the opportunity to talk in public, topics, which have come up in your psychotherapy, will not be brought up by me. Generally, no identifiable information from your psychotherapy will be shared with anyone without your written consent. 

Confidentiality Limits

In Ontario registered psychotherapists must release information or report the related party:
- If they receives order by the court to testify or release records
- If there is a harm to a child under 16 years of age
- If client threatens to harm himself/herself or someone else

Letters/forms

During the psychotherapy process, should you need any letters/filled out forms from me to be sent or be brought by you to a third party including court, university, work place, the fee would be equal to ONE SESSION OF PSYCHOTHERAPY. This fee covers the time spent on writing the letter or filling out the related form(s) and also the time spent on further communications with the third party. As client, you will be required to fill out the “consent to release of information form” and pay the required fee. 

Disclaimer

Please be aware that my services do not include crisis intervention, and if you would be in need of immediate help or if you had suicidal thoughts, please call your local crisis center, dial 911, or present to the nearest emergency room. If you live in Toronto you can call the distress centre at 416-408-4357.

Timeliness

Once you have scheduled an appointment, it is your responsibility to remember the date and time of your session. If you happen to show up late, please note that your appointment will not be further extended and also the full session fee will be payable for the session. If you are unable to attend a scheduled session please let me know in advance at least 24 HOURS BEFORE THE SCHEDULED SESSION. If you do it less than the 24 hours before the scheduled time, you will be subject to the half session fee. 

This informed consent form is intended to discuss the potential risks in the circumstances in which electronic communication is expected to be used with the clients. I, as your psychotherapist will use reasonable means to protect the security and confidentiality of information sent and received using the electronic services including but are not limited to email, videoconferencing services, virtual whiteboards, Google drive, etc. However, because of the risks outlined below, I cannot guarantee the security and confidentiality of electronic communications.

RISKS of using electronic communicatioNS

• Emails can be misdirected or hacked, resulting in risk of being received by unintended and unknown recipients. Therefore, using email to discuss sensitive information can increase the risk of such information being disclosed to third parties.
• Emails can be easier to falsify than handwritten or signed hard copies. It is not feasible to verify the true identity of the sender, or to ensure that only the recipient can read the message once it has been sent.
• Videoconferencing might be open to interception by third parties.
• Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the sender and recipient.
• Even after the sender and recipient have deleted copies of electronic communications, back-up copies may exist on a computer system.
• Electronic communications may be disclosed in accordance with a duty to report or a court order.
• Employers and online services may have a legal right to inspect and keep electronic communications that pass through their system.
• Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.

If the services include electronic communication, the following applies:

• Email is not an appropriate mean for clinical discussions or examinations. Therefore, you and I will not use email to communicate sensitive information. You agree to inform me of any other types of information you specifically do not want to be sent via the electronic services.
• While I will attempt to review and respond in a timely fashion to your electronic communication, I cannot guarantee that all electronic communications will be reviewed and responded to within any specific period of time. Therefore, the services should not be used for any time-sensitive matters.
• I will not forward electronic communications to third parties, including family members, without your prior written consent, except as authorized or required by law.
• If you require immediate assistance, or if your condition appears serious or rapidly worsens, you should not rely on the electronic services, such as sending me an email. Rather, you should take other measures as appropriate, such as going to the nearest emergency department, or contacting your local distress centre or emergency services.
• You will be responsible to inform me of any changes in your email address, or other account information necessary to communicate via the electronic services.