Counselling Consent Form

TO BE SIGNED (in person) BY ALL COUNSELLING CLIENTS AT YOUR FIRST SESSION

The Women’s Resource Centre is a registered charity, licensed to provide counselling services. We value our relationship with our clients and believe that such relationship is the beacon in the healing process. 

We believe that each individual is unique and has their own way of addressing resolutions. Thus, we believe in a wellness model that helps our clients empower themselves and participate in their healing plan.

Here are your rights:

1. Unless there is an emergency, all the therapy sessions are private and confidential with the exception of specific exceptions described below:

a. Child, elder or dependant abuse,

b. Expressed threats of violence toward an ascertainable victim,

c. Detailed planning or concrete signs of future suicide attempts,

d. Sharing information is necessary to facilitate client care across multiple providers,

e. Sharing information is necessary for the treatment plan,

f. Requests from legal and administrative institutions.

2. With the Client's prior written consent, the Counsellor may legally speak to another healthcare provider or Client's family members in emergency situations. The Client may direct the Counsellor to share information with whomever the Client desires, and the Client may change his/her mind anytime and revoke the permission.

3. The Counsellor is allowed to keep brief notes of the therapy session which shall be kept in strict confidence. The Client may, at any time request a copy of the notes kept during the therapy session.

4. The Client may ask questions on what to expect during and after the therapy session.

5. The Client may decline to proceed with the therapy techniques suggested by the therapist.

6. The Client may cease to continue therapy anytime, without any impediment and may return to therapy anytime.

7. The therapist has the right to dismiss the Client from the course of therapy.

CONFIDENTIALITY AGREEMENT

All Women’s Resource Centre clients can be assured that any information received will be kept in the strictest confidence, in accordance with the WRC Confidentiality Policy and industry best practices. Exceptions to this include information regarding an individual’s intent to harm self or others and cases of suspected child, elder or vulnerable person abuse.

CANCELLATION POLICY

Clients can cancel or reschedule an appointment at anytime, up to 24 hours’ notice. If you cancel an appointment with less than 24 hours’ notice, or fail to show up, you will be charged for the appointment. If a client is a repeat ‘no-show’ a pause in service may be implemented until the client is ready to resume services responsibly and respectfully.

GRIEVANCE PROCEDURE

We believe that all feedback from clients is valuable for service development. If you have a complaint on our clinical services, please follow the procedure below:

1. Any complaint (written or verbal) should be reported to the Executive Director.

2. The ED will meet with the complainant to discuss the nature of the complaint. If necessary, a meeting will be held with the WRC team member concerned.

3. The ED will provide a response to the complainant within 10 business days of receiving the complaint.

4. If dissatisfied with the outcome, the complainant may seek a hearing with the Board of Directors.

Any complaint concerning the Executive Director should be referred to the Chairperson of the WRC Board of Directors.