Consent to Treatment & Confidentiality Statement
The purpose of this form is to share important principles that guide the counselling process so that your decision to proceed in working together is based on accurate, informed expectations. Please read this form carefully and feel free to ask any questions about what you have read and/or obtain further clarification. Informed consent is a client’s full and active participation in decisions that affect them and complete freedom of choice based on the information shared.
Purpose & Nature of Counselling
When people engage in counselling, they are often ready for change in some aspect of their life. Counselling can lead to improved mental health by helping you better understand your thoughts, emotions and behaviours. It can also improve your relationships, how you relate to others, and the world. The number of counselling sessions you have depends on the goals you set and how long it takes to reach these goals. Your counsellor will work collaboratively with you to help you set and achieve your goals while facilitating personal growth through the counselling process.
Counselling also presents risks. Counselling tends to bring up uncomfortable feelings and difficult memories. Sometimes people feel worse before they begin to feel better. Some find that, as they experiment with new ways of thinking and behaving, relationships with others can be altered or disrupted. You are encouraged to share any feelings of fear, concern or doubt about the counselling process at any time during your sessions.
Collection & Storage of Personal Information
The personal information you provide upon intake in addition to session notes are kept in your file which is locked in a secure location and can only be accessed by your counsellor. By your written request you may have a copy of your records.
Information gathered through your work with us is confidential with the following exceptions:
If information is shared that indicates a child protection concern, where a child or children may be at risk of abuse or neglect, we are required by law to report the information to the Ministry of Child and Family Development.
If information is shared that indicates risk or threat of harm to any individual, whether yourself or another person, such concerns will be reported to appropriate authorities.
In compliance with a subpoena.
The nature of the therapeutic process often involves that a client shares personal information that may be of a confidential nature. Therefore, should there be any legal proceedings (such as, but not limited to, divorce and custody disputes, injuries), the client agrees that neither the client nor their attorney, or anyone else acting on a client’s behalf, will ask the counsellor to testify in court or any other proceeding, nor will a disclosure of client records be requested by the client's attorney, or anyone else acting on a client’s behalf.
We may, on occasion, consult a clinical supervisor on your case in order to provide you with the best care, however, your confidentiality will be strictly maintained and your name will not be used.
Online communication is not 100% secure. There are risks involved and it is important that you are aware we cannot guarantee your protection. We use Zoom for online counselling sessions which provides some level of communication security and privacy over the Internet for applications such as the web. It is also up to you to secure your privacy by being in a private space when participating in online counselling and ensure you are not connected to a public network. If the risks associated with online counselling are of concern to you we suggest using in-person or telephone counselling.
As a client, you have the right to:
Refuse a particular counselling technique or to stop counselling at any time
Be referred to another counsellor or health professional
To ask questions about our approach, background and experience or any other topics that will impact your ability or choice to engage in counselling
To refuse or say no to anything we suggest or any approach we use
Counsellor Rights & Online Counselling
Regardless of where in the world you are when you participate in online counselling with Tamara Childs, should a legal claim be brought forth by you as a result of online counselling with Tamara Childs, you agree to file the demand or proceeding inside Canada. Tamara Childs Wellness Ltd. is based in Canada and all services provided are done so under Canadian laws and jurisdiction.
Tamara Childs is a Registered Clinical Counsellor (#17947) with the BC Association of Clinical Counsellors (BCACC). Tamara Childs has a Master of Arts in Counselling Psychology as well as a Bachelor of Arts in Psychology.
Fees, Cancellation & No Show Policy
Fees (including 5% GST) are $126 for the initial 60-minute intake session; $126 per 50-minute subsequent session; and $189 per 80-minute subsequent session as per BCACC fee guidelines. Fees are due on or before the day that services are provided via e-transfer to firstname.lastname@example.org.
We reserve the right to post-pone future sessions until fees have been paid. We require at least 24-hours notice if you are unable to make your session or need to reschedule. Pre-paid amounts for sessions where 24-hours notice has been given for changes or cancellations will be credited to future sessions or refunded if services have been discontinued. For sessions when less than 24-hours notice has been given for changes or cancellations or there is a no-show, 50% of the session fee will be charged for the first incident, and 100% of the session fee will be charged for subsequent ones. We reserve the right to discontinue services after multiple cancellations or a no show appointment based on our discretion. If you are unable to attend an online counselling session due to technical difficulties or otherwise, our cancellation and no show policies remain in effect.
You can contact us by email at email@example.com or at 250-687-1604 (call or text). If you have an emergency, please call 911. For immediate mental health support please contact your local crisis line. In BC, the mental health support line is 1-800-784-2433 and the suicide crisis line is 1-800-784-2433. Also available for youth aged 5-20 years old is the Kids Help Phone at 1-800-668-6868.
Agreement to Proceed
Upon completing an online booking, you will have an opportunity to indicate if you have read the above and wish to proceed with counselling. If you have any questions, comments or concerns, please feel free to direct them to Tamara at any point via email or in session.