CONSENT FOR ONLINE COUNSELLING
It is the client’s responsibility to inform the therapist with a minimum of 48 hours notice if a session is to be cancelled. If the client fails to make the appointment and has not given appropriate notice regular fees will be charged.
Clients contacting the therapist more than 20 minutes after the session was scheduled to begin may consider the session cancelled and are responsible for payment.
It is the responsibility of the client to contact the therapist at the commencement of each session. Payment for each session is required in advance and fees are subject to an increase of $5-10 annually on January 1st.
If a client does not schedule for 3 months (12 weeks) and wishes to return at a later date they will re-enter the practice at the new fee, should it have changed.
Information that is shared during session is confidential and the Play Clinic Therapist(s) adhere to the professional standards regarding sharing of such information. If you want counselling information sent to another agency, written consent is required. This consent remains valid for 12 months from the date of your signature unless you make a request to withdraw your consent at an earlier time in writing. All interactions with the Play Clinic therapist, including scheduling of or attendance at appointments, content of your sessions, progress in counselling, and your records are confidential. Confidential files are kept for 10yrs or 10yrs past the child's 18th birthday. In cases of sexual abuse, files are kept indefintely.
EXCEPTIONS TO CONFIDENTIALITY:
• The Play Clinic therapist(s) works as a team under supervision of a reputable and qualified therapist. Your therapist may consult with another therapist to provide the best possible care to you and your child. These consultations are for professional and training purposes.
• If there is evidence of clear and imminent danger of harm to self and/or others, the Play Clinic therapist(s) are legally required to report this information to the authorities responsible for ensuring safety.
• By law the Play Clinic therapist(s) are required to report to the Children’s Aid Society (FACS) any and all incidents that may indicate possible child abuse and/or neglect.
• Your record is subpoenaed by the courts.
Should you have a concern about the ethical workings of your therapist, you may pursue such concerns with the chair of the Ontario College of Social Workers and Social Service Workers who will take whatever action may be deemed appropriate.
DECLARATION OF UNDERSTANDING
I acknowledge that I have read and understand the above and any questions pertaining to the above have been answered by Jodie Hiebert. I agree to abide by the conditions outlined above.