Informed consent is an important part of the therapeutic relationship, ensuring you are held safely and ethically in the care of a health professional.

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This page provides you with information about your rights and responsibilities, as well as my obligations as regulated health professionals. It also outlines fees and other important considerations.

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Please read each of the statements below and indicate you understand by using the appropriate check boxes, then dating and signing the document.

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This information will be reviewed in your first session and you are welcome to bring questions at any time.

1 - Confidentiality Duty

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All communications all records relating to the provision of therapy services are confidential and cannot be disclosed without the client’s (or guardian’s) written consent.

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All personal information is collected, used, and stored in accordance with Alberta’s Health Information Act (HIA) and Canada’s Personal Information Protection and Electronic Documents Act (PIPEDA).

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Legal and ethical obligations may require me to share confidential information when:

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• There is risk of imminent danger to self or others

• There is reasonable suspicion that a child, elder, vulnerable person, or animal is being abused, neglected, or is at risk of abuse

• The court issues a subpoena regarding information that has been shared in therapy or obtained as a part of an assessment

2 - Privacy Rights

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Confidentiality is my professional duty, whereas, privacy has to do with your rights and the limitations therein. You have the right to have your information safeguarded.

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Privacy laws intersect in the modern world, particularly where technologies are used to facilitate communication. Certain platforms used to facilitate connection are accessed by way of user agreements. These have inherent limitations. Safeguards are implemented in order to mitigate any breech of privacy.

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I use a secure videoconferencing platform and retain appropriate licenses to ensure all technologies are used in a secure and compliant fashion. I take every precaution to protect your privacy with regard to all communications.

In the event that my safeguards fail, I will notify you immediately and initiate procedures outlined in my cyber security policies.

3 - Releasing Information

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Subject to the conditions above, consent to the release of any of your personal information must be obtained before any disclosure.

I have a form that can be signed in situations where notes, forms, recommendations, or referrals become needed.

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Verbal consent may be sufficient at times, however, written consent may be additionally required and will be discussed with you, as necessary.

4 - Risks and Benefits

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Therapy may provide significant benefits including but not limited to, resolution of presenting issues, strengthens relationships, and an increase of coping, self-care, insight and healing.

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Therapy may also pose risks including but not limited to; experiencing uncomfortable thoughts and feelings, recalling troubling memories, and confronting difficult issues in various areas of your life.

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I encourage you to communicate your experiences with me throughout the therapeutic process in order to minimize risks and maximize benefits.

Therapy is most effective when you are comfortable with your therapist. If you do not feel comfortable or connected, I encourage you to communicate this openly so that I may ensure you are referred to someone who may be a better fit.

5 - Your Rights and Responsibilities

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You have the right to be treated with respect, dignity, and without discrimination regardless of your age, gender, mental and physical status, sexual orientation, race, belief system, or ethnic background.

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You have the right to receive mental health services from an ethical and competent professional whose work is grounded in evidence and held accountable by a public body. More information about my regulatory bodies can be found on my website.

You have the right to ask questions at any time and be informed about the qualifications, areas of specialization, scope and framework of practice, and codes of ethics that I am held accountable to.

6 - Appointments and Fees

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Your appointment time has been reserved for you and so I request that you make every effort to arrive on time and prepared for sessions.

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If you need to cancel or reschedule your appointment, please provide at least 48 hours notice in order to avoid being charged for the session. Late cancellations and no shows will be invoiced at the regular rate.

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My regular rate is $180 per hour. I can occasionally offer a sliding scale, depending on need and how you were referred.

Therapy sessions are typically 50 minutes in duration. The remaining 10 minutes of the 'therapy hour' are dedicated to necessary record keeping.

I can occasionally extend the length of a session after the session has started on a case by case basis. Additional time, as well as any reports, letters, consulting, or professional correspondence are billed in 15 minute increments at the regular rate.

Payment is due within 15 days of the receipt of the service. E-transfers are the preferred method of payment and a receipt is emailed once the payment has been accepted.

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Direct billing with some insurance providers can be arranged. Depending on your coverage, you may be responsible for paying the balance of your invoice.

7 - Contact Between Sessions

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It is necessary for us to set boundaries around the nature and extent of communication. This is done to retain your privacy and honour our duty of confidentiality and professional conduct.

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I am often not immediately available by telephone or email. At these times, you may leave a voicemail or send an email and I will respond as soon as possible.

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Contact between sessions should be for scheduling, requests for letters/release of information, or referral and resource information.

Clients are invited to send venting/update emails and voicemails, which will be reviewed and moved to your file for discussion at your next session. Please note that venting emails and voicemails will often not get a response. If you want a response, please indicate this in your message.

Given the nature of my work, I am not in a position to provide crisis support. If you feel unable to keep yourself safe, please contact your local crisis line, call 911, or visit your local urgent care centre

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I do not discuss therapeutic information outside of sessions. Public interactions will be greeted with a smile. If clients decide to acknowledge or engage, I will limit interactions in order to avoid dual relationships.

Additional Signatory (Parent/Guardian, Partner, Child, etc.):