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Consents

Partner/Third-Party Payor Consent to Counselling Services:

Let's begin your journey of healing!

We’re honoured to support you on this path. Please note that psychological counselling is conducted in accordance with the agreements below and all applicable laws. These agreements will be thoroughly discussed and signed prior to the start of counselling. If you have any questions or need clarification at any point, don’t hesitate to reach out to your Psychologist or Counsellor for guidance or clarification.

Please note that, unless you were emailed a direct link to this form, you are almost certainly at the wrong form and should complete our Full Consent Forms. This form mainly exists to accommodate a very specific subset of our clientele (mostly comprised of first responders and relief organizations) where counselling will be 100% funded by a third party or partners of those who have already completed the full forms.

 

For partner or third-party payor in-office or virtual/remote counselling sessions, you will need to complete only two forms: our Standard Consent and our Virtual Therapy Consent. (Our credit card authorization form is not necessary.)

To provide the highest standard of privacy currently available, we exclusively promote the use of Wire for our Virtual Therapy sessions.

Additionally, please be aware that we require at least 48 hours’ notice for any cancellation or schedule changes. If a session is missed without proper notice, our standard session fee for the missed sessions may be applied. This policy is not intended to be punitive. It is in place to ensure that we can continue to offer timely services to all who need them. Thank you for your understanding.

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.

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.

  • 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.

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

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Contact us

403 819 3545 (Text message capable)

info@henze-associates.com (iMessage capable)

403 819 3545, (Toll Free) 1 877 922 3143

Please email or text for information or bookings.

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