Client Registration Form

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Client Privacy, Confidentiality and Cancellation

Consent for Participation

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Psychotherapy and Counselling is a working cooperative relationship between you and your counsellor. Each member of this cooperative relationship has certain responsibilities. Your counsellor will contribute their knowledge, expertise, and clinical skills. You, as the client, have the responsibility to bring an attitude of collaboration and a commitment to the therapeutic process. While there are no guarantees regarding the outcome of the treatment, your commitment may increase the likelihood of a satisfactory experience.

I. Appointments, Cancellations and Fees

  1. Appointments will vary in length from 30 mins to 90 mins or as otherwise stipulated in a defined program offering and will take place on a regular basis. Your appointment time is made especially for you. If you are unable to keep an appointment, please cancel as soon as possible. You will be allowed to cancel four sessions within a one-year period with no charge. The year begins on the date of your First Scheduled Appointment. After four cancelled appointments you will be responsible for payment of missed sessions. If you are able to reschedule your appointment within five working days, it will not count as a cancellation. We ask that you pay for the session prior to your session each week online or directly to the counsellor. If less than 24 hours notice is given for cancellation or you fail to attend your session, you will be required to pay the full fee. Our aim is to deliver services timeously as agreed while retaining the right to reschedule appointments if necessary for any reason. We will endeavour where possible to give reasonable advance notice of any appointment change.
  2. During your initial consultation you will be assigned a program sessions fee and payment plan. Should your financial circumstances change during the course of your program of counselling therapy or if you have other concerns regarding your financial capacity to complete your therapy, then please discuss these matters with your counsellor. This practice seeks to be accessible and affordable to the broadest spectrum of persons. As is necessary from time to time, our fees will be subject to change and without notice based on particular program inclusions and the need to deliver a professional service.
  3. If an agent or agency is covering the cost of sessions, payment for each session must be paid before therapy commencement excepting when different terms may otherwise have been agreed upon in writing prior to the rendering of services.

II. Confidentiality

  1. Communication between you and your counsellor is confidential. This means that your counsellor will not discuss your case orally or in writing without your expressed written permission (please see the following section on “Training and Supervision”). 
  2. Your counsellor has an ethical and legal obligation to break confidentiality under the following circumstances: a. If there is a reason to believe there is an occurrence of child, elder, or dependent adult abuse or neglect. b. If there is reason to believe that you have serious intent to harm yourself, someone else, or property by a violent act you may commit.
  3. If you disclose that you knowingly develop, duplicate, print, download, stream, or access through any electronic or digital media or exchanges, a film, photograph, video in which a child is engaged in an act of obscene sexual conduct. d. If you introduce your emotional condition into a legal proceeding – that is, if there is a court or legal order for release of your records.

III. Training and Clinical Supervision

  1. All counsellors and associates of Rohan Watson Counselling & Coaching (RWCC) are under the supervision of clinical supervisors as required by the relevant professional association.
  2. To ensure the ongoing provision of quality service and effective training, sessions are sometimes video or audio recorded. This will only occur with the expressed permission of the client at the time. If you wish to discuss this clause further, please speak to your counsellor before signing this disclosure. Videos are viewed by Rohan Watson or a delegate of RWCC and are erased in a timely manner. You must agree/disagree to be taped prior to receiving counselling.
  3. Should your counsellor need to terminate services prior to the end of your planned therapy, all reasonable steps will be taken to ensure a smooth transition. This may include referral to another professional counsellor or mental health practitioner upon your permission.
  4. Counsellors are required to take written notes of the session. This is to ensure accurate record of discussions from each session. By signing below, you give consent for notes to be taken.

IV. Counsellor Availability and After Hours Emergencies

Counsellors check for voice mail messages during normal business hours. Messages left outside of normal business hours of operation will be picked up the next business day. Counsellors may respond to messages outside of usual business hours. If you have an emergency that needs immediate attention you may need to seek assistance at the nearest emergency services department or contact 000.

V. Additional Rights and Responsibilities

In addition to your right to confidentiality, you have the right to end your counselling at any time for whatever reason and without any obligation with the exception of payment of fees for services already provided. You have the right to question any aspect of your treatment with your counsellor. You also have the right to expect that your counsellor will maintain professional and ethical boundaries by not entering into other personal, financial, or professional relationships with you. RWCC reserves the right to discontinue counselling at any time including, but not limited to, a violation by you of this Consent for Therapy; a change to or re-evaluation of your therapeutic needs; or our ability to address those needs; or other circumstances that may lead us to conclude in its sole and absolute discretion that your counselling needs would be better served at an another therapeutic facility. Under such circumstances, RWCC may suggest an appropriate Practitioner or Agency for consideration.

VI. Consent

Your submission of the consent form indicates that you have read and understand this information and have received a copy of this consent form and give permission to RWCC to provide counselling services and that this contract is binding for all future sessions you may have with this entity.

I hereby agree to participate fully in the sessions and I demonstrate willingness to engage for the entire duration of the program. I understand what the program entails and totally agree that it is my decision to participate and take full responsibility for the outcomes or consequences that may result notwithstanding the obligations of RWCC’s duty of care. I understand that I am required to pay the full fees for services and if I choose to withdraw my participation from the program that I will be required to pay fees up to and including the week of conclusion of services rendered. I also agree to be contacted by RWCC for the duration of the program.