PORT CITY COUNSELLING SERVICES CLIENT CONSENT FORM

COUNSELLING:

Counseling is a confidential process designed to help you address your concerns, come to a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. It involves a relationship between you and a trained therapist who has the desire and willingness to help you accomplish your individual goals. Counseling involves sharing sensitive, personal, and private information that may at times be distressing. During the course of counseling, there may be periods of increased anxiety or confusion. The outcome of counseling is often positive; however, the level of satisfaction for any individual is not predictable. Your therapist is available to support you throughout the counseling process.

CONFIDENTIALITY:

All interactions with Counseling Services, including scheduling of or attendance at appointments, content of your sessions, progress in counseling, and your records are confidential. No record of counselling is contained in any academic, educational, or job placement file. You may request in writing that the counseling staff release specific information about your counselling to persons you designate.

EXCEPTIONS TO CONFIDENTIALITY:

•     The counseling staff works as a team. Your therapist may consult with other counseling staff to provide the best possible care. These consultations are for professional and training purposes.

 •     If there is evidence of clear and imminent danger of harm to self and/or others, a therapist is legally required to report this information to the authorities responsible for ensuring safety.

•     Canadian federal law requires that staff of PCCS who learn of, or strongly suspect, physical or sexual abuse or neglect of any person under 18 years of age must report this information to child protection services.

•     A court order, issued by a judge, may require PCCS staff to release information contained in records and/or require a therapist to testify in a court hearing.

FEES AND BILLING:

Individual one-on-one counselling per hour: $115.

Online counselling per hour: $95.

We appreciate prompt arrival for appointments. Please notify us if you will be late. Twenty-four hour notice of cancellation allows us to use the time for others. Clients will be billed for missed appointments without giving Twenty-four hour notice.