What You Can Expect:

· To be treated with respect and have your dignity upheld at all times.
· A holistic approach to counselling that supports your mind, body, emotions, and spirit.
· Confidentiality within professional guidelines to ensure your privacy and safety.
· A comprehensive, multidisciplinary approach that may, with your consent, involve consultation with medical, spiritual, and professional resources, as well as supervision to provide you with the best care possible.
· A variety of therapeutic interventions, which may include individual, couple, group, or co-counselor therapy.
· The right to end counselling at any time, with the option to have your records sent to a care provider of your choice.
· The right to have someone present during your counselling sessions if you wish.
· The freedom to share any or all aspects of your counselling experience with anyone you choose.
· The right to request an evaluation of your counselling by a qualified professional.
· The ability to decline any aspect of therapy that you're not comfortable with.
· Equal treatment, regardless of age, gender, race, religion, or disability.
· The right to verify your counsellor's qualifications as a registered psychologist.
· Assurance that your counsellor will prioritize your safety and the safety of others.
· Understanding that confidentiality will be secondary to protecting life and safety when necessary.
· A referral to another provider if your counsellor cannot meet your specific needs.
· Fees for services will follow the current rates recommended by the Psychologists' Association of Alberta.
· The possibility of modern technology, such as video or audio recording, being used as part of your therapy or for safety purposes.

What You Cannot Expect:

· Confidentiality in situations involving criminal, severe self-harm, or societally dangerous actions; especially when others cannot protect themselves. Your therapist has a duty to warn if such circumstances arise.
· Confidentiality in the case of legal or professional action against your counsellor initiated by you, on your behalf, or related to your counselling.
· That your therapist will withhold records or testimony if required by a court.
· That your counselling records or therapist's testimony will be beneficial to legal proceedings. Records are maintained for therapeutic purposes, not for court use.
· Continuous availability of your therapist at all times, though every effort will be made to provide access to resources when needed.
· That your therapist will act against their professional beliefs regarding what is in your best interest. If your needs conflict with these beliefs, your therapist may refer you to someone whose values align with yours.
· That your therapist will prescribe medications, as this is beyond their scope of practice.

I hereby consent to psychological services as described in the document provided above.

ONLINE THERAPY – INFORMED CONSENT

Welcome to online therapy! Please read and check off the following statements as you understand them. At the start of your first session, we will discuss and answer any questions you may have.

Online Therapy: Online therapy, using interactive audio and/or video and/or email, can be a highly beneficial part or entirety of therapy but it may not be appropriate or successful for all therapy needs. If face-to-face therapy is more appropriate, we will offer an appointment or provide referrals.

Confidentiality: Everything shared during therapy is confidential. However, when disclosure is necessary to protect you from immediate and grave harm, to safeguard another person’s mental or physical health or safety, to ensure the safety of the public or if ordered by the courts, the therapist is required to disclose.

Privacy: While we take every precaution to ensure online therapy is completely private, you still accept the risk that the transmission could possibly be accessed by unauthorized persons.

Appointments and Charges for Services: Payment is due via pre-authorized credit card at the time of appointment and you agree that, should you not provide the required 48-hours' notice of cancellation/rescheduling, it will result in a full charge for the missed session.

Limitations: It is important to realize that online therapy is intended to provide quality information, practical answers to psychological issues, and therapy for present problems. This service may not be suitable for some types of in-depth psychotherapy.

When should I seek traditional mental health treatment rather than internet therapy?

• If you are having thoughts of suicide, harming someone else, or psychotic symptoms, please call emergency services at 911 or the Alberta Health-Link 811 toll-free access number.
• If you are in an abusive or violent relationship.
• If you have been seriously depressed.
• If you have a serious substance abuse problem.
• If you are under 18 years of age.

Technical Difficulties: It is understood that when communicating by internet or other electronic means, disruptions in service or other technical difficulties will likely occur from time to time. Should a disruption occur at a time of crisis, you agree to immediately phone me at 403-819-3545.

By signing this form:

• I agree that I reside in the province of Alberta, Canada.
• I have signed and returned a standard Consent to Counselling Services and a Credit Card Authorization Form.
• I have read, understood, and accepted the above policies and I agree to participate in online psychotherapy.

I agree to the terms and conditions as stated in the provided consent form for online psychological services.

Credit Card Authorization Form

The contents of this form are inputted directly into the incredibly detailed verification system required by our merchant service provider. As such any deviation from the information your credit card company has on file (as displayed on your credit card statement) will cause the registration of your credit card information to be declined. Please ensure that the below information exactly matches the information displayed on your current credit card statement.

Terms and Conditions

Total amount of payment currently authorized: $249.99 (Including GST where applicable).

Please request a session booking via telephone or e-mail before sending us this form.

This authorization for repeat sessions is considered valid until revoked and a typewritten signature shall be considered as valid as hand-signed.

I, the undersigned client, acknowledge that I have read and understand Henze & Associates' cancellation policy and authorize them to bill my credit card for the above amount in the event I do not cancel in the required (48-hours minimum) time frame.

I authorize the use of my credit card for payment of psychological services rendered.