INFORMED CONSENT /SERVICE AGREEMENT

Thanks for submitting!

By signing this document, I hereby agree that my electronic signature has the same legal status as my handwritten signature and is legally binding. 

CLIENT-THERAPIST SERVICE AGREEMENT

INFORMED CONSENT

 

Welcome to Vision Counselling and Consulting. As a client you have certain rights and responsibilities that are important for you to understand. Therapy is about achieving the goals you want for your life. They may be long-term goals or short-term goals, you as the client determine what these are with support from your therapist. Your therapist may make suggestions and/or recommendation on how clients can reach their goals. 

 

There are no guarantees that therapy will work for you. Progress can be slow and sometimes therapy can bring up unpleasant memories and emotions. This is a common aspect of recovery. Therapy requires commitment and requires active and consistent effort to be successful. It is necessary to apply the strategies discussed during sessions in your daily life to achieve progress and recovery.  

 

Appointments will be 50 minutes in duration and scheduled at your pace. Frequency of sessions may be discussed between client and therapist, and may be more or less frequent as needed. The scheduled appointment is assigned to you and you only. If you need to cancel or reschedule, please provide 24 hours advance notice. With the exception of rare and unforeseeable circumstances subject to the therapist discretion, a late cancellation charge of $90 will apply. This fee may not be waived on more than two occasions per client within a 6-month period. Sessions are not covered by OHIP or AHS (or the governing health body of your region). 

 

Plans are available at a discounted rate and may be canceled without penalty from time of purchase until 24 hours before start time of first session within plan. Plans are not available when direct billing session cost through private extended insurance providers. Plans may be cancelled at any time after this, however used sessions will be charged at their regular price rather than the stated plan discount price and the remaining balance will be refunded. If plan is purchased 24 hours before first session start time then the above stated cancellation fee will apply. 

 

You are responsible for making payment arrangements with your therapist to pay for your sessions, if sessions are not paid using the website. Please see FAQs for available methods of payment. Should you fail to pay the required session cost, the therapist reserves the right to seek legal remedy and/or the use of a collection agency to secure payment. Fees are reviewed periodically and subject to change. Dependent on your region, social work services are considered a medical expense and may be submitted for a medical tax credit when you file your income tax return.

 

For clients utilizing insurance direct billing:

By signing this form, you are agreeing that you hereby provide consent for your private extended health insurance provider to make payment for services to your mental health service provider directly

 

Your therapist may not be available immediately by telephone. Phones are not answered when in sessions with clients or therapist is unavailable. During these times, please leave a confidential voicemail to your therapist and your call will be returned within one or two business days. If you feel your call is of an urgent nature and/or you are unable to keep yourself safe, please visit your local hospital or call 911 (or emergency services number for your region).