Counseling Consent Form

Your personal information shared in this intake form will be kept strictly confidential within our therapeutic team. We prioritize creating a safe and supportive environment for your healing journey, and your trust in our confidentiality measures is crucial to the therapeutic relationship.

Informed Consent

Counsellor Qualifications 

I am aware that all counsellors working with Complex Trauma Resources (CTR) have completed a Master’s Degree in counselling or psychology and are registered with the BC Association of Clinical Counselors (BCACC), and I have been given a chance to ask questions regarding my counsellor’s education, experience, and professional membership.

Counselling Approach 

I recognize that my therapist may employ different evidence-based methods and interventions during our sessions, chosen through mutual agreement. I understand my right to discontinue counselling at any point and to decline the use of a specific method or intervention. If I encounter any concerns about the counselling process, I will communicate them with my therapist. I also understand that I can end therapy whenever I choose.

Counselling Advantages 

Therapy can help me gain fresh insights into my challenges and acquire new strategies for coping with or resolving them. It has the potential to facilitate the development of new skills and behaviours, enhance stress management capabilities, and foster a deeper understanding of myself and others.

Therapeutic Risks 

I acknowledge being informed that while therapy offers potential benefits, success is not guaranteed, and there are associated risks. I am aware that emotions and memories may surface during therapy, leading to intense feelings, and shifts in awareness may impact my self-perception and interpersonal dynamics. Recognizing that personal change is a unique and diverse process, I commit to promptly addressing any questions or concerns with my therapist for timely resolution.

Counselling Connection 

I acknowledge that my relationship with my counsellor is confidential, and they will not disclose the nature of our relationship. My counsellor will not openly acknowledge our connection in public or social settings, but I am free to do so if I choose.

Privacy & Confidentiality

I acknowledge that any information shared with my counsellor will be stored in my file, which will be retained for seven years after my last session. Session notes are securely stored online in a private drive within Complex Trauma Resources, with access limited to my counsellor and CTR’s clinical director. I recognize that texts, voicemails, and emails are not entirely secure and agree to limit their use to scheduling or modifying appointments, refraining from sharing personal therapeutic information through these means.

I am informed that there are limitations to the confidentiality of counselling services. These limitations include situations where:

• There is an imminent danger to myself or others, requiring necessary preventive actions by law.

• A child or vulnerable adult is at risk, necessitating a report to the appropriate agency/authority.

• A court order mandates the release of information.

Additionally, I understand that confidentiality will not be maintained between me and additional attendees involved in the therapeutic session with me.

Documentation & Record Keeping

I comprehend that my counsellor will electronically document our sessions, and session notes are securely stored online in a private drive within Complex Trauma Resources. I have addressed any concerns about note-taking and data storage with my counsellor. 

I can request copies of my counselling notes. However, my counselor may not fulfill documentation requests from third parties (e.g., benefit providers for long-term and/or short-term disability benefits) without discussing and evaluating them in consultation with me.

Policies & Procedures 

Fee Arrangement for the Provision of Services

CTR Counseling offers specialized support and therapeutic practice at $160 per 50-minute session. This price applies to individual, couple, and group settings.

Fees paid to a registered clinical counsellor may be reimbursed by your extended health benefits, which may be provided by an employer. Check with your extended benefit plans regarding your coverage. 

CTR cannot provide direct billing but will give you a detailed receipt upon payment. If you have concerns regarding the cost or have a limited number of sessions through your extended benefits provider, please discuss additional funding options with your counsellor. 

Consent to Fee Schedule

I agree to pay in full for each 60-minute session at the beginning of each session unless other arrangements have been agreed upon. I am aware that I will pay by e-transfer to info@complextrauma.ca.

Consent to Cancellation Policy

If I cannot attend a scheduled appointment, I understand that I must provide at least 24 hours' cancellation notice. Failure to do so will result in being charged half of the usual fee for the session ($90.00) unless another arrangement is agreed upon. 

Consent to Late Policy

My counsellor will be ready to meet virtually at our scheduled time. If I do not arrive virtually within the first 10 minutes, my counsellor will attempt to call me on my provided phone numbers, following my emergency contact if I am unreachable. If my counsellor cannot make contact within the first 15 minutes, a missed appointment fee will apply (half of the session rate, to be paid before rebooking unless other arrangements are made).

Communication Policy

My counsellor checks emails regularly and will inform me if ‘out of office’. I acknowledge that if I do not hear back within 2 business days, I can contact info@complextrauma.ca for an update.

Crisis Support 

I understand that my counsellor cannot provide mental health crisis support and is only available during scheduled appointments. For urgent mental health support, I will contact my local crisis line or Emergency Department. In case of a mental health emergency, I can call 911 for immediate assistance.

Social Media Policy 

I know several people manage CTR’s social media accounts, and the best way to communicate with my counsellor is by email or the contact phone number they provide.

Consent to Communication Policies 

I understand the communication limits of my counsellor and acknowledge that they will only respond to emails within office hours. My counsellor does not provide crisis support, and I will seek emergency medical attention for suicidal thoughts or a mental health crisis. I acknowledge that my counsellor does not communicate through social media platforms.

Virtual Counseling

I understand that all CTR counselling appointments will be virtual and that I should be in a comfortable and private location with a reliable internet connection. I will minimize distractions and avoid driving during virtual counselling sessions.

• If the session is disconnected, my counsellor will attempt to call the provided phone number, possibly appearing as 'unknown.'

• If I am disconnected or unreachable and there is concern for my well-being, my counsellor may contact the emergency contact provided.

• If my counsellor is concerned for my well-being and unable to contact me or the emergency contact, my counsellor may contact emergency services.

I am aware that online counselling will take place via Zoom or through doxy.me (see https://doxy.me/en/patients/ for details). I can decline this option and reschedule at no extra fee. I consent to Virtual Counseling and understand the benefits and limits of virtual health appointments.